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EHR needs better health information exchange, federal council says

White House advisers want greater health information exchange among providers. To accomplish this, they suggest a universal language for electronic health record systems.

Health information technology interoperability must be enabled through universal language exchange -- and it must happen soon, with federal government help, according to a White House technology council.

The President's Council of Advisors on Science and Technology (PCAST) issued its final health IT report Dec. 8. The report is based on last summer's hearings, during which the council listened to recommendations from its Health and Life Sciences Subcommittee, which suggested, among other things, that it need not be expensive or complex to implement health information exchange.

The PCAST report reaches six conclusions about the health care industry and about where providers and policymakers should focus their efforts to boost the adoption of electronic health records (EHRs) in the next few years.

Among those conclusions is the need to ramp up health information exchange and create a universal language for doing it. Developing standardized methods of exchange among EHRs has been an ongoing issue for the health care industry. As more meaningful use criteria are established in the next four years, it will be increasingly important to have a universal language that allows different, proprietary technologies to "talk" with one another. Federal officials should lead that effort to develop the language standard, PCAST said in its report.

"While the ability to exchange and integrate health data offers great advantages to patients, the economic benefits of these capabilities do not accrue directly to specific providers, or to providers' incumbent EHR system vendor (if any)," the council wrote. "As a result, market forces are unlikely to generate appropriate incentives for the necessary coordination to occur spontaneously."

The majority of the work to develop such standards would be conducted in the private sector, but the government can collaborate to bring stakeholders together, according to Eric Lander, director of the Broad Institute of the Massachusetts Institute of Technology and Harvard University, and co-chair of PCAST. "That is a classic role for the federal government," he said during a teleconference presenting the final report.

Though the rule expresses an intent to require more robust exchange of health information among providers at later stages of meaningful use, its initial requirements … are very modest.

President's Council of Advisors on Science and Technology

The ability for providers to exchange personal health information is key to improving the quality of care and engaging patients in their own treatment. Officials involved in developing criteria for meaningful use have included health information exchange capabilities within the Stage 1 criteria. That's not enough, however, according to the council.

"Though the rule expresses an intent to require more robust exchange of health information among providers at later stages of meaningful use, its initial requirements that EHR systems communicate with each other are very modest. This creates a danger that EHR adoption during early stages of meaningful use may exacerbate the problem of incompatible legacy systems," the council wrote.

During the teleconference, Dr. David Blumenthal, the national coordinator for health IT, said that his office would seek comments from the industry on the PCAST report and look at integrating its suggestions "as speedily as possible."

The Office of the National Coordinator for Health Information Technology, which is overseeing the development of criteria for meaningful use in conjunction with the Centers for Medicare & Medicaid Services, expects to emphasize health information exchange in the Stage 2 criteria currently being worked on. The PCAST report is timely for that work, Blumenthal said.

Information exchange advocates welcomed the PCAST report, saying its recommendations build on the efforts to foster adoption detailed through the Health Information Technology for Economic and Clinical Health, or HITECH, Act of the 2009 stimulus law. "The legislation laid the groundwork for a national initiative; this report highlights areas where we can make improvements that will accelerate the adoption and use of health IT in all areas of health care," said Jennifer Covich Bordenick, CEO of the eHealth Initiative, in a statement.

Let us know what you think about the story; email Jean DerGurahian, News Writer.

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