Remember the adage, "Those who do not remember the past are condemned to repeat it?"
Well, that appears to be the case again, this time with health information exchanges (HIEs), which are running into some of the same rough waters as the electronic health records before them.
The HIEs are the next level in health information technology, now that EHRs have become more commonplace. But they're no longer being touted as the easy solution to get all of those proprietary EHRs to share data by serving as central repositories for the information. It seems like for every step forward or every success story, there's a step backward. Or two.
For instance, in recent weeks we've heard that HIEs can work as intended to share data, with Rochester's RHIO (what a throwback word that seems to be) helping providers share imaging tests, thus reducing the need for unnecessary duplicative testing and thereby reducing costs and improving patient care.
There's also HIMSS' survey, finding that in the past year HIEs have improved their data sharing capabilities in a number of areas, such as summary of care records, reporting to registries, and patient access; they've also beefed up their privacy and security efforts.
But these gains tend to get overshadowed by the problems HIEs keep on facing. For instance:
- Some of them, beset by political, operational and/or financial troubles, can't even get off the ground and are basically dead on arrival.
- Some that are functional have still been plagued by health IT challenges, such as lack of interoperability, data capture and quality issues, as well as lack of support by their state and/or providers they're meant to serve.
- The RAND Corporation revealed that HIEs are still experiments and that it's not yet known whether they're effective.
- Three Senators have instructed the Government Accountability Office to investigate the HIEs that received almost $600 million in grant money from ONC but still struggled to succeed.
And across the pond, Great Britain's National Health Service admits that it ignored thousands of patient requests to opt out of a similar centralized database similar to an HIE because it discovered a systems flaw that would cause those patients to miss out on certain treatments, such as cancer screenings. Many American HIEs also use an opt-out patient consent model.
Instead of rolling out in smooth, orderly fashion, HIEs are lurching, in fits and starts--and sometimes not forward.
Just like EHR adoption.
Why is this happening? Is it lack of adequate governmental oversight, allowing HIEs to function without adequate accountability? Is it lack of uniformity, which allowed too much flexibility in HIE governance and business models? Is it the abandonment of a national health information network in favor of small entities that perhaps cannot afford to operate well? Is it poor allocation of the grant money or provision of the money with not enough strings attached? The fact that patients don't trust these faceless entities with their health records? That HIEs were tasked to accomplish goals that were too ambitions to meet?
And why didn't people learn from the troubled rollout of EHRs? We're dealing with many of the same issues: too much variation, lack of usability, security concerns, hard-to-reach goals, costs, etc.
Without the HIEs--or some other way to achieve interoperability--it will be extremely difficult for providers to meet the requirements of Meaningful Use, not to mention enjoy the clinical and other benefits of data sharing. But I haven't heard many suggestions to bolster HIE success or provide them with any needed support going forward so that they don't falter and trip.