HIE hurdles include lack of patient ID standards and technical knowledge

In testimony to be presented at a meeting of the Health IT Policy and HIT Standards Committees tomorrow in Washington, D.C., several providers and other health IT stakeholders discuss opportunities, as well as barriers, to the implementation of health information exchange. While several of the latter are identified, the general tone of the testimony is one of optimism for the future of HIEs.

Talking about technical and business barriers and opportunities for HIE, Bill Spooner, CIO at San Diego-based integrated delivery network Sharp HealthCare, says that as electronic health record adoption continues to spread, HIE will prove to be a "necessary element" for supporting quality and affordable care.

"Information exchange is fundamental to [accountable care organizations], the patient-centered medical home, population health management and such similar care concepts," Spooner says. "The highest quality, most cost-effective patient care requires a complete and accurate health record, based on consistent data definitions and patient identification. The health reform carrot may well be more effective than the regulatory stick in furthering HIE adoption."

Still, Spooner points out, HIE remains in its "infancy." Even with large amounts of financial help from the federal government; he attributes the slow growth to a "lack of mature, agreed standards around interfaces, patient consent and patient identification."

To remedy the situation, Spooner proposes that future standards and certification requirements "enable complete interoperability … in a manner that the received data becomes actionable in the receiving EHR." He also says that the Office of the National Coordinator for Health IT needs to ensure that accurate patient identification occurs at "an optimal cost," and that HIE organizations need to figure out how to become financially sustainable beyond ONC grant money.

David Kibbe, president and CEO of DirectTrust.org, an independent non-profit trade group of Direct community participants created to promote and enforce best practices for maintaining security and trust for Directed exchange, says that with regard to governance opportunities, "significant progress" has been made.

"We are much closer than most people realize to achieving widespread health information exchange over the Internet that is secure, easy to use, and capable of connecting people working in unaffiliated healthcare organizations, health information organizations, and across multiple vendors' products," Kibbe says.

He points out that governance barriers include a lack of knowledge or understanding about the "most basic technical and business practice elements of Direct."

"We have found that even highly competent healthcare IT technologists from established companies are often unfamiliar with the domain of identity, credential, and access management [ICAM] that is central to Directed exchange implementations," Kibbe says. "Many have some basic understanding of the uses of digital certificates within a Public Key Infrastructure [PKI], but are not knowledgeable about the way that the protocols and specifications for Directed exchange operate and implement them."

Kibbe adds that "limiting the liability of trusted agents … who provide Directed exchange services" to providers also remains as a hurdle to governance. "There is a perception that the transport of electronic messages via Directed exchange that will include personally identifiable health information of patients and consumers may place at additional risk the parties who transport the data," he says.

Participants at a town hall meeting held by ONC on Jan. 17 talked about a need for more federal guidance for HIE governance, citing a concern about a lack of technical standards and distrust among providers and security of patient information.  

To learn more:
- here are the meeting's materials
- read Spooner's testimony (.pdf)
- here's Kibbe's testimony