Since we launched FierceEMR back in June, I've continually struggled with the question of whether health information exchange fits in with this publication, or whether it's better suited for another FierceMarkets title like FierceHealthIT. So many HIEs and RHIOs have started operations with administrative and billing information rather than true clinical data--if they even got off the ground in the first place.
Now, it's becoming clear that I, too, must lose the silo mentality that's hampered interoperability in healthcare for so many years. The clincher for me was a story I read in Federal Computer Week yesterday about five major decisions that may determine whether federal health IT efforts will be worth the billions of dollars U.S. taxpayers are spending. (FCW pegs the maximum total outlay at $45 billion, in line with what I've recently been seeing. Remember, the popular $19.2 billion figure is a net estimate, after accounting for expected efficiency gains from HIT.)
The key questions that FCW poses are:
1. Will HHS be innovative, or simply follow the stimulus law to the letter?
2. How broadly will HHS define "meaningful use"?
3. Will HHS be flexible in understanding that not all providers can get EMRs in place as fast as others?
4. Will the Nationwide Health Information Network be built from the top down, or start at the state level?
5. Should HHS wait for wide-ranging healthcare reform before making a major health IT push?
I agree that each one of these is an important question that could make or break the EMR incentive program, but the ones about meaningful use and the NHIN really answer my own question about health information exchange. The point of EMRs is more than just to reduce the volume of paper and make healthcare organizations operate more efficiently. EMRs must help prevent medical errors and improve population health. You'll never reduce expensive duplication, ensure that clinicians have complete and accurate information at the point of care and truly manage chronic diseases across multiple care settings without interoperability.
On the question of state leadership in building the NHIN, we're already seeing some states becoming models for others to follow. Last month, we reported that Mississippi's Division of Medicaid has enlisted Shared Health, a division of BlueCross BlueShield of Tennessee, to build a system of interoperable records for 600,000 Medicaid enrollees in the Magnolia State. Though I retain my skepticism about EMRs derived from claims data, Shared Health has demonstrated some positive results with information exchange in its home state of Tennessee, and laid some of the foundation for provider organizations to connect their EMRs to the network when they're ready.
EMRs aren't complete without interoperability, and HIE most certainly isn't complete without EMRs. - Neil