by: Tom Swett, CPHIMS, CPHQ, and Prerak Joshi
Health Information Exchanges (HIEs) are integral to the patient-centered transformation that healthcare systems, patients, payers, clinicians, and ancillary patient service supporters are currently experiencing.
The basic function that HIEs perform is to enable patient health information sharing across disparate electronic healthcare record (EHR) technologies. This sharing of patient health information enables hospitals, physician groups, payers, and other support organizations to share patient health information in a fast, secure and efficient manner. Implementation and utilization of HIEs essentially involves the connecting and leveraging of the recent and widespread deployment of EHRs in the United States.
This HIE evolution will require substantial changes to existing business and clinical processes, and a critical starting point is reaching out to relevant stakeholders whose interests are central and whose support is vital – physician engagement is central to this effort. This article is intended to provide a brief discussion of outreach efforts made to the physician community, including an overview of some of the significant benefits and potential challenges that this group may encounter with HIEs.
In August of 2013, the federal Agency for Healthcare Research and Quality (AHRQ) estimated that there were over 280 HIEs across the country, and that more than 50% of the hospitals in the U.S. are participating in HIE-enabled organizations. While this may seem like an impressive state of progress, it is important to note that hospital participation does not equate to physician participation, as the vast majority of physicians are not employed by hospitals. According to the Office of the National Coordinator for Health Information Technology (ONC) just 39% of physicians exchanged information with other providers in 2013, and only 14% performed those exchanges with providers outside of their organizations. Further, only 5% of physicians exchanged information with outside hospitals. Last month, Black Book Rankings stated: “In 2015, 72 percent of multi-provider networks and hospital systems are considering private HIEs for standardized sharing of patient data. In 2013, this figure was 33 percent.” Clearly, efforts to engage in effective outreach to physicians to promote and grow HIEs is crucial for wider HIE deployment, adoption, utilization and success within the US.
Connecting EHRs via HIEs appears to be an inevitable but positive course of action. Prominent healthcare IT organizations are taking steps to facilitate this move – for instance, the EHR/HIE Interoperability Workgroup (IWG) has partnered with HIMSS and IHE USA to offer a pilot certification and testing program.
Professional healthcare organizations such as the American Medical Association (AMA) are also stepping up to educate and support their constituency on HIEs. At this important time when the scope, structure and operation of HIEs is being discussed and defined, the AMA’s engagement is laudable. As stated by the AMA, potential HIE benefits to physicians include point of care access to patient information, improved quality and continuity of care, reduced potential for patient harm, cost reduction through avoidance of duplicative services, coordination of care, and more efficient health care access for patients. On the other hand, challenges include unknown issues of liability, HIE viability and sustainability, new financial costs, data accuracy and completeness, issues of privacy, and data security.
Physicians, as primary users and beneficiaries of HIEs, need an objective source of expertise concerning HIEs, as well as evidence of their value and benefits, in order to encourage broader HIE implementation and adoption. The AMA’s outreach to its membership not only serves as a beacon to physicians, but it also serves as a model for other national and regional professional healthcare membership organizations (e.g., American Nurses Association, National Pharmacists Association) to likewise engage their members and assist them in understanding and supporting HIE efforts.
By engaging all HIE stakeholders, successful HIE models can not only be developed and refined, but also successfully deployed and utilized. This is an important part of larger nationwide efforts to improve the quality delivered by, operational efficiency achieved within, and satisfaction of patients across the US healthcare system.