HIEs: A Major Disconnect

HIEs: A Major DisconnectI recently came upon some unsettling information about the current state of HIEs (Health Information Exchanges). It was disturbing in light of the increasingly important role that interoperability plays in healthcare and because expectations are already being placed on many physicians regarding clinical data exchange. Much is written about the problems that HIEs face—the challenges most commonly being attributed to funding, business sustainability, and, in a recent post, insufficient EHR penetration. But what I discovered in conversations with a major HIE reveals an even bigger shortcoming.

A nationally known hospital system in a major metropolitan area has implemented an HIE operated by one of the biggest names in the world of health information exchange. One would expect this large company to be on the forefront of this emerging area of technology. However, this HIE vendor is incapable of accepting clinical data in the current, standard format (CCD—Continuity of Care Document), despite the fact that CCD has been recognized as the “new” standard since 2008. CCD was selected by the Healthcare Information Technology Standards Panel (HITSP), recognized by the Secretary of HHS, and named as the standard for clinical data exchange in the Meaningful Use regulations. This major HIE told us that CCD is “on their development roadmap,” and that they currently accept clinical data only in HL7 format.

The problem this creates is that, once again, physicians are left holding the bag! At this particular hospital, many of the independent physicians are members of an organization that represents their interests. They are implementing EHRs—which is a good thing—and are expected to participate in the HIE and to exchange data by the end of this year. However, their respective EHR vendors will have to maintain multiple standards to satisfy all of the various participants, and this will incur higher costs, which will ultimately be borne by the physicians.

How can we expect true sharing of data when not all parties that participate in information sharing are being held to the same standards—standards that have been established specifically for this purpose? Perhaps HIEs should be regulated to ensure compliance, just as EHRs and the physicians who implement them are.

HIEs and Information Sharing: Physicians Feel the Pressure

The exchange of clinical data is one of the three pillars of the EHR incentives program, and the legislation was intended to serve as a stimulus (pun intended!) for the creation of health information exchanges (HIEs) by including significant funding earmarked for their establishment. The stage 1 meaningful use requirements provide further support by requiring physicians to take a first step towards information sharing. EHR adoption was expected to be the impetus for the development and flourishing of HIEs.

HIE and Information Sharing - Physicians Feel the Pressure

It appears that it may be just the opposite—interest in HIEs may be driving adoption of EHRs, rather than the other way around. Growth in the HIE arena is coming from private HIEs—those sponsored by health care systems to connect their own providers and facilitate the effective sharing of clinical information about their mutual patients. The growth in private HIEs is far outstripping the growth in community HIEs, according to KLAS, and physicians are facing new and stepped-up pressures to participate.

It is no longer just the carrot of the meaningful use incentives at play. The following are just two examples that have recently been brought to my attention where sticks are being used to “encourage” physician participation in information sharing. The University Physicians Network (UPN) at NYU is making participation in its information-sharing network a requirement for membership in the UPN, without which physicians do not have access to the group’s favorably negotiated reimbursement rates. A similar physician group in Massachusetts is making membership in its network a prerequisite for patient referrals.

I’m interested in hearing from readers about the development of HIEs and other information-sharing networks in your markets, and the carrots and/or sticks associated with participation.