The successful exchange of health information among providers and insurers, as well as other healthcare players, will "unleash capabilities we can't even imagine," making the entire healthcare industry "even more productive," David Blumenthal, former national health IT coordinator, told attendees at the Pega Collaborative Healthcare Summit in Boston on Wednesday.
That's why Blumenthal said that getting patient information flowing throughout the continuum of care is one of the most important steps the industry can take, calling it the "next frontier."
Successful health information exchange (HIE) requires an "ultra large system" that's dynamic, innovative, and emergent enough that it adapts as healthcare changes in the future. But before such an HIE system is implemented, there are multiple challenges to overcome. Blumenthal noted that creating a robust exchange system isn't only an IT problem; rather, it's a problem of social, cultural, legal, institutional, economic, and political proportions. "The technical part is actually the least challenging aspect" of getting an HIE system up and running, he said.
What are the other keys to a successful health information exchange? Blumenthal outlined the four steps that must occur before providers and payers can electronically share patient information.
1. Economic policy
The biggest hindrance to achieving health information exchange is the overall lack of interest, particularly from providers who aren't motivated to overcome their deeply engrained economic plans to share information with competitors. "That's like saying BMW and Toyota should share their client list with each other," Blumenthal explained. "It's just not a natural act."
Providers will find reasons (e.g., privacy concerns, technical obstacles, and lack of standards) why they shouldn't exchange patient information throughout the industry. "We must reverse that motivation because if there's no will, there's no way," Blumenthal said. To that end, he suggested that payers configure new payment models that reward providers who share information. "Payment policy reform should make it more attractive to exchange information," he said.
2. New privacy and security legislation
Current privacy and security rules such as the Health Information Portability and Accountability Act were created in and for a paper world. Ten million Americans have been affected by a healthcare breach, creating a deep distrust of electronic information. "Although there's no one thing we can do to secure an HIE system, we can talk about the issue so the public knows we take privacy and security seriously," Blumenthal said.
He called for new regs aimed at the electronic age and, in the meantime, the industry should work to steadily improve privacy and security by establishing more visible, measured, and supportive protections. Providers particularly should work to decrease "poor data hygiene"--including lack of encryption--which causes 80 percent of breaches, Blumenthal said. "We need broad and aggressive national cyber security," he added.
3. Technical solutions
A system of electronic information exchange can't succeed without quality technical solutions, including standardized vocabulary and processes. Blumenthal suggested that the HIE system recreate the mail service process, establishing the equivalent of an envelope to send patient information, directions with secure addresses, and uniform delivery protocols. "There's room here for experimentation and piloting of alternative approaches," he said.
4. Clear governance
The only way to ensure that all players follow the rules within an HIE is to establish clear governance over the entire system. "Essentially, we need a FEMA for healthcare," Blumenthal said, that would ensure all providers and payers abide by standards, react to failures, and provide problem-solving capabilities. Perhaps most importantly, governance is needed to discipline bad actors within the system to help guarantee public trust. Whatever the governing body looks like, it must ensure the data are valid and reliable and can promptly manage any failures, he added. Like the electric grid and banking systems, an HIE system will become part of the nation's vital security infrastructure so governance is needed to help determine who owns the system and who is responsible for ensuring it works.
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