At its simplest, a health information exchange (HIE) "allows doctors, nurses … and patients to appropriately access and securely share a patient's vital medical information electronically; improving the speed, quality, safety, and cost of patient care," according to the Office of the National Coordinator for Health Information Technology (ONC).
Created under the HITECH Act, HIE delivery models can take the form of a single statewide exchange; local information exchanges; or technology available through commercial vendors.
But since their inception, HIEs have experienced a sometimes rocky and inconsistent roll out. What is happening in one state very often is quite different from another. And now that original federal funding has been exhausted, financial sustainability has become an issue as well. But that doesn't mean the dream of information exchange is defunct.
Laura McCrary is the executive director for the Kansas Health Information Network (KHIN), offering information exchange services to providers and healthcare facilities in Kansas. KHIN's members include over 800 healthcare providers and 100 hospitals throughout the state.
McCrary attributes strong participation to the quality of services that KHIN provides. "We have a highly robust health information exchange that … provides very good services to our members to help them meet their meaningful use requirements … improve patient care, and reduce costs for our patients in Kansas," she says.
If you believe that information exchange can benefit your practice and patients, here are the key factors to consider.
WHAT ARE THE CHALLENGES?
Physician Kenneth Salzman, a member of the Healthcare Information and Management Systems Society (HIMSS) Innovation Committee, says that adoption of EHRs rose to 78 percent in 2013, according to the ONC, yet only 14 percent of users were "exchanging information outside their organizations."
Furthermore, Physicians Practice's 2014 Technology Survey, Sponsored by Kareo, indicated that only 18 percent of more than 1,400 physician practices nationwide are part of a state-run or proprietary HIE.
There are a number of challenges to successfully exchanging information, not the least of which is cost. Independent medical practices that participate in HIEs often exchange patient data through a state or regional health information network, but in many cases they need to pay for technology upgrades and interfaces themselves, unless state funding is available. And there are usually fees to participate in an information exchange. KHIN charges a per provider annual fee and a one-time implementation fee, which pays for the cost of the interface itself and the connection to that interface.
According to a joint report by the Robert Wood Johnson Foundation, Harvard School of Public Health, and Mathmatica Policy Research, physicians are less enamored with information exchange when they are expected to pay for participation and do not see a clear and immediate benefit to themselves and their patients. That is partially the case for Mark Nunlist. Nunlist is a semi-retired primary-care physician based in White River Junction, Vt., who serves as a consultant for his former practice, White River Family Practice.
"Vermont … [has] a developing health information exchange and they have been very proactive in trying to get practices in the state to use health IT effectively," says Nunlist. But, he says the state government is considering passing the cost on to providers. "[My] sense is [they reason] we'll charge you $50 per provider per month to access [the exchange]. That doesn't sound like much when you are sitting at the state capitol, but when you have nine providers, that's $450 a month …."
If you stand on the roof of Nunlist's practice you can see the Dartmouth-Hitchcock Medical Center just across the Connecticut River in New Hampshire. With one half of White River's patients residing in New Hampshire and the other half in Vermont, that poses some unique challenges for the practice; especially when it comes to information exchange.
It is difficult for the practice to engage in full data exchange with Dartmouth-Hitchcock. Nunlist says the practice can access patient information through the hospital's EHR, but "the hospital cannot see the outpatient record, so it is a one-way street because there are different systems, and they are in different states, and there is not enough interconnectivity between health systems."
And while Nunlist sees the value in exchanging health information, he thinks the utility for independent medical practices is not there yet. "I don't think I see my partners logging on to a system in the middle of care to access information in the HIE until it's quite more sophisticated than I think it is [now]," he says.