As of late last year, just 24% of hospitals are participating in a health information exchange, but 54% more are planning to join one, according to the National eHealth Collaborative's 2011 HIE Study, which polled about 350 hospitals large and small. Those figures jibe with a Harris Interactive poll commissioned by HIE software vendor OptumInsight, in which 74% of 301 hospital CIO participants indicated their intention to achieve HIE connectivity by next year.
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Technical and competitive barriers sometimes get in the way of hospitals sharing data and connecting to large, public regional and statewide HIEs. The Maine HIE is up and running, porting data into physician electronic health record (EHR) systems across the state in real time. But Maine's the exception; most other states face difficulties accomplishing HIE connectivity and remain in the planning stages.
However, these difficulties aren't insurmountable, or at least they don't look that way to hospital IT leaders. According to the Harris survey, in addition to revealing plans to be in an HIE, 70% of CIOs indicated confidence in meeting meaningful use stage 2 criteria, which likely will require at least some baseline HIE connectivity, by 2014.
More nimble providers are not waiting for the government to incentivize health data exchange. This is especially true in radiology, where business depends on the ability to pass images between specialists and hospitals as well as primary care providers and, ultimately, to patients. Instead, these practices are setting up purpose-driven, private HIE implementations in order to exchange data with provider partners.
"As more and more non-radiology clinicians start going to electronic medical records, they're not very savvy. But then they see the need for getting away from the traditional ways of getting their reports -- from radiology, pathology or any other kind of reports," said Michael Abiri, M.D., chairman of the department of radiology for Continuum Health Partners, which is the parent company of the 1,400-bed Beth Israel Medical Center in New York. Specifically, that means more and more primary care physicians are now asking for those reports digitally ported into the EHR systems instead of paper and fax.
ACOs driving HIE connectivity, with slow progress
Beth Israel recently inked a five-year deal with CriticalKey LLC to sort out the complexities of porting radiology images and reports from the radiology information systems to more than 25 different provider EHR systems. While he estimates that about 80% of primary care physicians still are using faxes or CD-ROMs to receive radiology reports, more and more will go the HIE route – especially after hospitals set up accountable care organizations (ACOs) and establish infrastructure for advanced HIE connectivity.
Non-radiology clinicians….see the need for getting away from the traditional ways of getting their reports -- from radiology, pathology or any other kind of reports.
Michael Abiri, M.D., chairman, department of radiology, Continuum Health Partners
Abiri believes HIE connectivity could be a selling point to help hospitals recruit physicians to their ACO projects. But there's a long way to go, he said.
For instance, in the realm of pathology HIE, Quest Diagnostics Inc. -- the largest U.S. lab provider -- delivers patient results to physicians over the Web, not in real time but downloadable once a day via the Web. Abiri said that, while most of the bigger players in the pathology market have provided similar HIE connectivity, many smaller ones haven't even begun to address it. Meanwhile, hospital-based pathology departments are struggling to share lab results unless they have a dedicated outpatient EHR.
Beth Israel might reap benefits for its meaningful use compliance as well as bolster its participation in ACO-based care, Abiri said, but the hospital set up data sharing purely as "a market concern," he said. Hospital leaders also thought the process of pushing reports from Beth Israel's radiology department downstream to PCPs would be "very complicated."
"Once we did it with this large group of physicians that were basically unaffiliated with our system -- but they send all their cases to us -- [hospital leadership] was very happy about it," he said. "Now they're promoting their own [choice of] EMR to clinicians, supporting the PCPs or any of the physicians, going there and helping them set it up."