10 years of HIEs: Progress, but there's a long way to go

Nearly 10 years after the creation of the Office of the National Coordinator (ONC), the U.S. healthcare system is making advances in harnessing the power of health information to improve care, but many important health policy decisions will need to be confronted in the years ahead, concludes a report from the California HealthCare Foundation.

The report, "Ten Years In: Charting the Progress of Health Information Exchange in the U.S.," traces the history of the HITECH Act, healthcare reform, electronic health record adoption and health information exchange efforts.

"Now, after HITECH's investments, the primary question many experts are struggling with is: What constitutes the right mix of government HIT programs versus market forces to continue development of an HIT infrastructure that can support higher quality, more cost-effective health care?" it states.

Among the questions still to be answered:

  • Will a national HIE governance mechanism be implemented?
  • How will the country overcome barriers to sharing health information across state lines?
  • Will more regulation be required to ensure that stakeholders and vendors don't restrict data exchange that is in the best interests of patients?
  • What steps will need to be taken to ensure that all health care stakeholders fully participate in HIE?

As Mary Franz, executive director of health information technology for the Local Initiative Health Authority of Los Angeles County, pointed out recently, progress for many is slower than anyone expected.

The report notes concerns about gaps in adoption of EHRs, particularly in rural and low-income areas and among post-acute facilities. Some experts worry that a "digital divide" may be developing.

Some experts worry that Meaningful Use Stage 2 may be proceeding too quickly and its requirements may be too complex. Others are concerned about providers failing to use EHRs to their full potential, and that the requirements promote a "check the box" mentality. Still, others warn against overemphasis on the role of EHRs in care coordination and analytics.

For now, it appears the federal government's efforts will focus on standards-setting, certification and administration of the Meaningful Use Programs, and the states will pursue their own strategies, it says.

Meanwhile, day-to-day HIE activities, the report states, may increasingly involve private efforts to support a specific business initiative, such as an accountable care organization. That's a scenario a Black Book report predicted recently--it said 83 percent of the nation's public HIEs are stalling as federal funds dry up.

To learn more:
- find the report (.pdf)

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