Health information exchanges (HIEs) won't work well and interoperability will not be sustained unless the business models and incentives are changed, according to a new paper from the Brookings Institution.
The paper, written by Niam Yaraghi, a fellow in governance studies at the Center for Technology Innovation, posits that the interoperability problem is more economic and political than technical. In the current fee-for-service reimbursement format, as data sharing lowers costs, it serves as a disincentive for certain providers, such as physicians, labs and radiology centers.
Moreover, Stage 3 of the Meaningful Use program will likely set the interoperability bar too low, and will have the inadvertent consequence of helping not the providers but the dominant vendors, who will need only provide a minimum amount of interoperability, Yaraghi writes.
"Unless there is a system in which a part of the financial savings that occur as a result of health information exchange is shared between the entities that engage in exchanging information, there is no reason to believe that the providers will continue to actively exchange health information with each other. On the other hand, with the existence of a shared saving program in which all of the health care providers are held responsible and respectively rewarded for their efforts in exchanging medical information and collaborating in reducing the overall costs of services, I believe that interoperability will be achieved with minimal involvement of the government. The financial benefits of exchanging information will lead medical providers to independently seek IT systems that are capable of communicating with others and, with creating enough demand, the software vendors will ultimately have to find a technical solution for interoperability and produce IT systems which are capable of exchanging information with other systems," he states.
Yaraghi also recommends that the business model for HIEs be structured more like the financial industry's credit bureaus and be used to combine large amounts of raw data into customized analyses for providers, payers and even government agencies.
Interoperability is a priority of the government, with support from President Obama. The Office of the National Coordinator for Health IT just revealed its draft 10 year interoperability roadmap and is looking for public comment on it by April 3.
The Health and Human Services Department also announced Tuesday at the ONC's annual meeting held in the District of Columbia that it is offering a two-year grant program for $28 million to advance the adoption and use of interoperable health IT tools and services to support health information exchange.
To learn more:
- access the paper