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Obstacles Remain for Meaningful Use of Health IT

Carrie Vaughan, for HealthLeaders Media, December 29, 2009

There are still huge barriers to the meaningful use of health IT relating to security, health information exchange, decision support, and the secondary use of data collected in electronic health records. The government doesn't know how to surmount these obstacles, which is why Department of Health and Human Services announced it's providing $60 million in grants funded through the HITECH Act for Strategic Health IT Advanced Research Projects.

"This program will fund projects in areas of research where breakthrough advances are needed to address barriers in health IT adoption. Addressing these breakthrough areas will require the most advanced thinking the nation can bring to bear," David Blumenthal, MD, national coordinator for health information technology wrote in the HIT Buzz blog.

Not surprisingly, one of the targeted areas is related to health information exchanges, specifically to help develop applications and network platform architectures to electronically exchange clinical data and use health information in a secure, private, and accurate manner.

"By 2015 we are still going to have many of the same problems," says Chris Giancola, a principal consultant with CSC Healthcare Group, a Falls Church, VA-based global technology consultancy that has been the program manager for the New England Health Exchange Network.

"Data liquidity will have improved, which is wonderful because we are at least saying that we will be investing in things to move data," he says. "But the costs of healthcare and rate at which costs are increasing aren't going to change because I don't see the legislation impacting cost containment in a meaningful way."

To help address the financial challenges associated with health information exchanges, Giancola recently authored the report,"Creating a Financially Sustainable Health Information Exchange."

The report outlines three core principles that are necessary to establish a financially viable HIE based on CSC's work with the New England Health Exchange Network. NEHEN, which was formed 11 years ago to help address the mandates outlined in the HIPAA legislation, is a member-owned and privately funded HIE with about 50 participating members in New England area. The initial participants were motivated by the idea of exchanging a standard set of administrative actions so that they could rid themselves of clearing house transactions fees, says Giancola. "We started off with the administrative actions—claims files, checking patient eligibility, doing electronic referrals. Doing those transactions first show real dollars to the participants so that they can get behind it."

The report says healthcare organizations should target key payer and provider organizations to secure private funding, create a core value proposition that clearly demonstrates what the benefits are to all participants, and determine how costs will be fairly allocated between participants.

"You really need to start with looking at private funding and obtaining that rather than securing a grant first. Look at grant money as the gravy," says Giancola, adding that "forming a nexus around the large players is huge because once you have critical mass around the right payer and provider organizations everyone else will want to get involved."

Participants in NEHEN pay according to size. The smallest organizations don't pay the same as the largest, because the larger organizations stand to gain the most so they share more of the costs, explains Giancola. Organizations can also pay for additional services like exchanging a continuity-of-care document between two members.

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