Obstacles Remain for Meaningful Use of Health IT

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.

Today, one of the challenges NEHEN is facing, says Giancola, is restructuring the funding formula based on the requirements of ARRA and HITECH. "Payers were at the table and interested in participating because it saved them a great deal of money," he says.

Now that administrative data is a solved problem—for the most part—and payers are only involved in two of the nine different meaningful use recommendations for health information exchange, payers don't want to fund the exchange at the same rate, he says. "They don't think that they should bear as much of the burden any more and provider organizations have to pick up the slack."

There will need to be more of a fundamental shift in the financing model, says Giancola, explaining that it's going from administrative to doing more clinical transactions. "The providers will have to take on more of the financial burden for next few years," he says.

Therein lies the challenge—most providers are hard pressed to come up with the extra capital to add the technologies required by the HITECH Act. And while the incentive payments are nice and a great benefit, they don't cover all of the costs associated with installing and meaningfully using EHRs. Then again, providers can't afford being hit with penalties in 2015 and beyond, either. So if you have any solutions on how to make health information exchange financially viable, please pass it on.