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Trusted HIE could be a hit among HIT vendors, health care providers

We expected the HIT world to look at ONC's trusted health information exchange concept as another compliance mandate. Early returns show enthusiasm for the idea in some quarters.

NORWOOD, MA – Vendors, informatics-minded physicians and CIOs attending a Massachusetts Health Data Consortium conference on health information exchange had a few days to consider the federal HIT Policy Committee's daylong dissection of how certified – or trusted – HIE might work. The verdict: This idea, if executed in a well-planned manner, could catch on.

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Trusted HIE, said John Halamka, M.D., would make his job simpler because it would cut down the time and lawyer participation involved in hammering out Data Use and Reciprocal Support Agreements (DURSAs) that organizations currently exchanging health data must sign. In his positions as Beth Israel Deaconess Medical Center CIO and chair of New England Healthcare Exchange Network (NEHEN) -- overseeing HIE construction across Massachusetts – Halamka said trusted HIE certification might not eliminate the need for DURSAs, but it would standardize them and send the lawyers currently involved in customizing them looking for other work.

"What we do today, it's all bilateral DURSAs: You and I want to start exchanging data, and my attorneys get to call your attorneys and your attorneys get to call my attorneys, and we'll spend about a month getting a data-use agreement in place, and when your friend wants to start exchanging data, we do the whole thing all over again," Halamka said.

Trusted HIE will help HIT leaders, he hopes, spend more time with implementing cool technologies than wrangling over clauses in DURSAs. "My experience is that the technology is ready, but the policy is not," Halamka said. "With accountable care, we're going to have an exploding number of trading partners. …With this trusted network entity or idea – conditions for network trust – that fact that [a potential HIE partner] is certified means, 'We can trust them, turn it on.'"

Larry Garber, M.D. runs SAFE Health, a small central Massachusetts HIE from his position as Medical Director for Informatics at Reliant Medical Group in Worcester. He thinks the idea of trusted HIE is "nice but insufficient" in its current hypothetical form, which of course could iterate many times during pilot project and federal rulemaking processes before its final version is published in the Federal Register.

We don't want [a] sort of recommendation, we want to be told what the standard is so all of us can meet and achieve it.

Kevin Ferriter, program manager, InterSystems

In its present form, Garber said, trusted HIE certification doesn't do nearly enough to take into account the variations between state privacy laws that complicate data exchange. That and costs could be a barrier to entry for this voluntary trusted HIE certification -- especially for smaller health care providers.

"If it's the same cost they charge EHR vendors [for meaningful use certification], that's going to be a huge barrier," Garber said. He provided input to HITPC through the HIE Workgroup, of which he's a member. Despite these potential wrinkles to iron out, he believes trusted HIE is a necessary building block of the "network of networks" that eventually will avail every patient's data to physicians no matter where they roam in the U.S.

On a vendor panel, conferencegoers asked representatives from four HIE vendors – InterSystems, Orion Health, Alere-Wellogic and Informatics Corporation of America -- what they thought of the idea of trusted HIE and how it would affect the construction of a national HIE network as well as the live exchange of data. They all demurred, volunteering only that they were watching it wend its way through the various advisory committees to the Office of the National Coordinator for Health IT (ONC).

Speaking with SearchHealthIT, however, InterSystems program manager for North American HIE implementations Kevin Ferriter said that while he can't speak for all HIE vendors, he thinks that trusted HIE is a "much needed" idea – as long as ONC implements certification in a very clear, prescriptive way.

"We don't want [a] sort of recommendation, we want to be told what the standard is so all of us can meet and achieve it," Ferriter said. And, he added, he'd like to see ONC create a framework for being able to confirm and share information about who has achieved trusted HIE certification.

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