The number of operational community-based HIEs sharing data electronically among hospitals, physicians, health plans, and patients increased by nearly 40% since last year, according to the Washington DC-based nonprofit eHealth Initiative's sixth annual survey. There are roughly 193 active programs involved in health information exchanges, 57 of which reported being operational in 2009, the survey found.
I'm certainly coming across more examples of health information exchanges. Here are two HIEs that I read about in just the past couple of weeks.
New York Clinical Information Exchange. Comprised of nine hospitals and two other health institutions in New York this exchange has started sharing data for emergency patients. The EDs use a Web portal to access information on patients, including demographics, lab and pathology test results, discharge summaries, and medication histories. The exchange also feeds data to a project sponsored by the New York State Department of Health Centers for Disease Control that is studying the role of HIEs in biosurveillance.
Transforming Healthcare in Connecticut Communities. A coalition of hospitals, physician practices, federally qualified health centers, insurers and employers in Connecticut aim to build a statewide health information exchange; support small physicians efforts to implement electronic health records, develop training and deployment tools for physicians and healthcare workers; and develop quality measures and performance improvement targets. The THICC initiative will initially be funded solely by THICC members and will work in conjunction with the Connecticut Department of Public Health. The exchange will rely on Web-based components and community systems that hospitals and doctors can use to share patient health summaries and clinical data like x-rays.
The American Recovery and Reinvestment Act of 2009 has definitely helped to, as the report says, "energize this field." Not surprisingly, since the care goals for the "meaningful use" requirement that providers must attain to receive stimulus funding include communicating with public health agencies and exchanging meaningful clinical information among the professional healthcare team. According to the HIT Policy committee's "meaningful use" recommendations for 2011, providers should:
- Have the capability to electronically exchange key clinical information, such as problem lists, medication lists, allergies, and test results among healthcare providers and patient-authorized entities.
- Perform medication reconciliation at relevant encounters and each transition of care, i.e. implement the ability to exchange health information with external clinical entities.
- Be able to submit electronic data to immunization registries and provide actual submissions where required and accepted, i.e. report up-to-date status for childhood immunizations.
Last week, HIT Standards Committee recommended that providers implement the 12 HITSP endorsed standard capabilities, including being able to transmit in-hospital and out-patient prescriptions, structured health data for discharge summary and continuity of care documents, and lab test results. Having an initial set of standards and "meaningful use" definitions to work from is a good first step, but there is still a long way to go before the health industry reaches "meaningful interoperability."
Troyen A. Brennan, MD, executive vice president and chief medical officer for CVS Caremark, is not sure how quickly the industry can achieve interoperability. The biggest barrier is "deciding exactly what that interoperability is going to look like," says Brennan, who has had experience in various sectors of the industry. He served as chief medical officer for Aetna Inc., president and CEO of Boston's Brigham and Women's Physicians Organization and as a director of quality measurement and improvement in the hospital setting.
"If I have my patients on an EHR in an ambulatory setting how will that be informed by and inform people in the hospital who see my patients," says Brennan. "Exactly how that information gets shared is a tough part that we haven't exactly worked out."