Up at 5AM: The 5AM Solutions Blog

Simplifying HIE: Strategies to Make Things Easier

Posted on Thu, May 31, 2012 @ 06:00 AM

obamahitechIn 2009, the Health Information Technology for Economic and Clinical Health (HITECH) act was created (as part of the American Recovery and Reinvestment Act) to stimulate the migration of medical records from a paper model to an electronic one. HITECH includes Meaningful Use (MU), which are guidelines to encourage and enforce the use of electronic health records (EHRs) by doctors, clinics, hospitals, and care delivery systems throughout the country. There are three key components that define meaningful use:

  • The use of a certified EHR in a meaningful manner (such as for referrals or e-prescribing).

  • The use of certified EHR technology for electronic exchange of health information, to improve health care quality.

  • The use of certified EHR technology to submit quality and other measures.

The latter two elements support the idea that we cannot move from paper-based information silos to electronic information silos. This is why health information exchange (HIE) is built into the package – to ensure that digitizing records realizes a natural benefit – digital records are easier to transmit.

But still, the secure exchange of health information is fraught – and difficult. The Office of the National Coordinator for Health IT (ONC) facilitated the creation of the Nationwide Health Information Network (NwHIN), which is both a network for health exchange and a set of technical specifications defining how it should be done. The NwHIN Exchange has grown slowly and shared real lessons from the cutting edge of health IT. States struggle to create and nurture Health Information Exchange Organization that can engage exchange on a county, region, or state-wide level. An overwhelming array of standards and technologies make it confusing for physicians and hospitals to know how and where to invest. And the power of MU lies in its carrot and stick approach, which includes incentive payments to those who do MU, followed up with penalties to those who don’t. (For detailed info on MU, see http://healthit.hhs.gov/portal/server.pt?open=512&objID=2996&mode=2 ).

When you consistently get best-practice aficionados, standards organizations, and government agencies together around a common goal, you start to get Big Ideas around health information exchange. We see some simple strategies emerge that should make the evolution of HIE easier.

  • Don’t make it hard. Doctors and state health information exchange organizations have work to do that does not involve understanding standards and learning technology. Too many HIT solutions hit us over the head with IT. It’s not about the technology – it’s about getting information where it needs to go, in the simplest way possible.

  • Start simply. Right now, health information exchange occurs primarily in the form of poorly photocopied notes, or faxes. It’s simple and it works. While digitizing every data element likely will expand our horizons of quality and understanding (assuming we find a way to wrangle and make sense of the data), let’s not overcomplicate for technology’s sake. While complete system-to-system integration is a fantastic goal, system-to-human is a fantastic way to start.

  • Can it go in the cloud? Yes. And for many who will benefit from health information exchange, a hosted Internet solution is the way to do it. For adopters, the cloud can mean ease, simplicity, and a focus on treating patients instead of managing software.

  • Growth lies in choice. While the “simplest” method of achieving health information exchange is to use a single solution, power lies in the multitude. Meaningful Use presents noble goals, which will be achieved, exceeded, and made better through innovation. The idea of exchange in itself empowers diversity, and it’s the diversity of approaches and solutions that will help MU enable better care at lower cost.

  • Use the network. The idea behind state health information exchanges and regional health information organizations (RHIOs) is to start locally and create data hubs to enable exchange intra-regionally and inter-regionally. While there’s obvious value in enabling doctor-to-doctor exchanges, there’s power, simplicity, and savings in pooling resources to federate, house, or enable data exchange.

There are probably more solutions than problems in our nation’s healthcare system – ways to make care more efficient, to improve quality, to lower costs, to support research, to enable public health, to better engage patients in their health and care. We just need to keep moving forward as thoughtful stewards of the evolution of approaches to health IT and health information exchange, as the NwHIN enters a new phase and Meaningful Use enters its next stage. There will be inevitable questions and complications as progress continues – which clearheaded, simple approaches can answer.

-Leslie Power, 5AM Solutions

Tags: EHR, electronic health records, electronic health record, Office of the National Coordinator for Health IT, ONC, Health Information Exchange, HIE, meaningful use

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