Break down all barriers to health information exchange

Farzad Mostashari, National Coordinator for Health IT, discussed the obstacles to the interoperability of health information systems in a recent interview with HealthLeaders Media. To overcome these barriers, he said, the cost of HIEs must be reduced, their value must be increased, and the "preconditions for trust" among providers must be created.

The Office of the National Coordinator for Health IT (ONC), he noted, is developing standards that will lower the cost by making interfaces easier to build. At the same time, ONC is working with the states to ensure that all healthcare providers have access to HIEs, he said.

As for the value of HIE, Mostashari pointed out that public and private payers "are putting out new models for paying for care that rewards coordination [so] we're seeing the value proposition start to emerge for information exchange." He added that while trust among providers develops slowly, he believes it will begin in local networks and gradually spread.

You'd expect this optimism from the Obama Administration's point man on health IT. A dispassionate observer might note that, with the exception of the Direct Project, which allows providers to push clinical data from point A to point B, the government's standards development is still in an early stage. And, aside from a few states such as Colorado, Maryland, and Rhode Island, the state HIE projects--on which the feds have lavished half a billion dollars--have yet to bear much fruit.

The value proposition of HIE depends on the formation of accountable care organizations and patient-centered medical homes, and the willingness of payers to reward providers who create those entities. While much has been said about these models, only a small percentage of healthcare organizations have become involved in them, to date. As for trust, the main precondition is the willingness of competing healthcare organizations to work together for the good of all.

Later in the same interview, Mostashari was asked whether the disengagement of patients from healthcare was a major barrier to reform. He replied that there was some truth to that assertion. Part of the problem, he said, lay with patients themselves; but he added that doctors may also "get our hackles up when patients ask for copies of their records, which is all too often the approach that some providers have taken."

Confirming this assertion, a recent survey found that while nearly all patients would like to see their doctors' visit notes online, far fewer physicians are open to this concept. The majority of responding physicians feared that sharing visit notes would confuse patients and increase their own work. Another study of VA patients revealed that the majority of them would like to share information in their personal health records--which are derived from the VA's electronic health record--with family members, caregivers, and/or non-VA healthcare providers.

While few observers still believe that PHRs will replace EHRs as the repository of clinical data for health information exchange, patients do want access to their health records--something that the Meaningful Use program specifically promotes. And it appears that some patients who use PHRs are likely to make the data in them available to all of their providers. PHR users also are more likely to be engaged in their own healthcare than people who lack this information.

So when we talk about health information exchange, perhaps we should broaden the definition to include provider-patient data interchange. Let's break down every silo impeding the free flow of information that can improve healthcare. - Ken

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