Although HIEs may not be the unmitigated disasters that a recent NHINWatch guest column published on Jan. 13, 2013, contends, what is clear is that the ad hoc, fragmented and uncoordinated processes health information exchange (HIE) organizations and HIE infrastructure vendors are using to attract and connect to physician practices are woefully ineffective. Without the ability for physicians to easily transmit and access patient data in a usable format there will be limited participation and this, in turn, will create a negative "snowball" effect that will limit the benefits that HIEs can offer. The result: HIEs won't be able to deliver on their intended goals of offering a single source for all providers to access and retrieve clinical data to provide safer and more timely, efficient, effective and equitable patient-centered care.
Currently, the onus on interfacing with the hundreds of existing electronic health records (EHRs) usually falls on individual HIEs and their connectivity vendors. It typically takes at least six months for an HIE to complete just one EHR interface. Every EHR integration requires an HIE to reinvent interoperability processes and interface specifications because of the lack of standardization, collaboration and repeatable methods. Even after achieving this milestone, the HIE must endure another substantial wait to enable the EHR vendor and/or HIE to educate the appropriate physician practices about how to fully utilize the HIE network.
This means that about 200 bandwidth-challenged HIEs are each devoting scarce resources and time on one-off projects, which severely limits how quickly HIEs can offer the interoperability needed to access near-real-time data from continuity of care documents (CCDs), lab results, imaging study reports, transcribed notes and reports, and so on, as well as transmit key information from and into the EHR. Obstacles driving this inefficient, time-consuming, resource-draining approach include:
• Data exchanged within the HL7 standards framework still has wide variability, creating issues when HIEs merely pass along lab, data and transcribed notes without “normalizing” the data and mapping medical terminology.
• HIE services and processes differ widely with some HIEs offering access to a wide array of data generated throughout the continuum of care while others provide much more limited options that may require a physician practice to interface directly with a hospital or lab to obtain and import lab results into their EHR.
• A survey conducted by Doctors Helping Doctors Transform Health Care, published on January 28, 2013, by Clinical Innovation + Technology, reported that 71 percent of the 527 responding physicians cited that the lack of interoperability among various EHR systems was preventing them from participating in an HIE.
• Some HIEs don't provide the data physicians want and need, which also limits their HIE participation. For example, the survey respondents indicated that it's very important that they receive timely information during transitions of care, such as:
− Medication lists
− Relevant lab and imaging test results
− Discharge summaries
− Reasons for referral
− Treatment summaries and changes recommended by a consulting physician
EHR vendors have the ability to change the course of this unsustainable, time-consuming, resource draining, inefficient meandering journey toward interoperability. We believe that EHR vendors should take the lead in creating the value needed to attract physicians', as well as hospitals', labs', imaging centers' and other provider participation and ensure their continued financial support as the initial funding for many HIEs ends. Efforts to link EHRs to HIEs and achieve EHR interoperability can proceed faster and more smoothly if EHR vendors proactively approach and collaborate directly with HIE entities to accelerate interoperability by assuming responsibility for integrating their products.
To succeed, it makes sense for EHR vendors and HIEs to prioritize decision-making and actions by applying the Pareto Principle (or the 80-20 rule) that focuses on addressing the 20 percent of the issues that cause 80 percent of the problems. Specifically, they must focus on executing what is doable now rather than in the future and deliver valuable information and services that providers need to make almost instantaneous point-of-care patient care decisions and run their practices more efficiently. Unfortunately, all too often, HIEs go down a rabbit hole to accommodate requests that are important only to a small, but vocal group of providers, but fail to offer value to other clinicians or patients.
We recommend the following activities as a good place for other EHR vendors to start the process:
• Simplify logistics and utilize resources effectively by developing standard processes and procedures that align with the HIE technology partner.
• Create interface "bundles" based on standard protocols that can be used repeatedly with minor adjustments to streamline integration.
• Partner with HIEs to conduct joint physician outreach and education.
The current HIE connectivity approach obviously isn’t working. It does not make sense for HIEs or HIE infrastructure vendors to craft one-off connectivity plans for each EHR being used by providers within an HIE’s service area. EHR vendors are in the best position to eliminate those inefficiencies because they have relationships with clients all over the country, making it easier for them to bring doctors, hospitals and HIEs together.
Robyn Leone is director of public policy and government initiatives at e-MDs a leading developer of integrated electronic health records and practice management software for physician practices and enterprises.