Current efforts to organize health information exchanges receive low marks from CIOs, according to a recent survey by healthsystemCIO.com. Ninety-two percent of responding CIOs said that local, regional, state and national HIE efforts were duplicative, and 60 percent described HIE initiatives in their state as a "confused mess."
The CIOs placed part of the blame for this state of affairs on the Office of the National Coordinator for Health IT (ONC). Forty-six percent of respondents said ONC's performance in creating a "rational HIE framework and funding mechanism" was "not so good." Nineteen percent said ONC's track record was "poor," and 30 percent called it "average."
To be fair, ONC has not had a great deal of control in this area. Under provisions of the HITECH Act, the agency was directed to dispense about half a billion dollars to state-designated HIE-building entities after making sure their applications met federal standards. After that, ONC had no legislated role.
Perhaps Congress should have taken a different approach: instead of providing the money to the states to create statewide HIEs, the government might have gotten more bang for its buck by directly subsidizing exchanges in the local markets, where healthcare is actually provided. But even in that case, there's no guarantee that the HIEs would have created sustainable business models.
The healthsystemCIO.com survey reveals a sharp division of opinion over whether data exchange standards are ready for prime time. Twenty-three percent of the CIOs said they were; 38 percent said that they would be ready within the next two years; another 38 percent said that it would take longer than two years.
Even among the CIOs who feel that current standards are adequate to facilitate information exchange, some believed that the infrastructure for the Direct Project needed upgrading, that vendors were not adopting the standards that exist, and that the government should stop changing the rules with reports like that of the President's Council of Advisors on Science and Technology.
And now for the good news: Nearly 70 percent of the respondents said their organizations either were exchanging, or planned to exchange, data with other healthcare systems that competed with them. It's not clear how many of these systems already are involved in such activities, but it's heartwarming to see that the Meaningful Use requirement for data interchange across business boundaries is starting to have an effect.
To learn more:
- see the results of the healthsystemCIO.com poll