Safe & Sound with Marianne Kolbasuk McGee

A Call for HIE, Interoperability Help

Success of Health Reform, EHR Rollout at Stake

Timely federal guidance on best practices for secure health information exchange is critical to the long-term success of healthcare reform as well as the HITECH Act electronic health record incentive program.

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Here's why:

  • The Centers for Medicare and Medicaid Services on Jan 10 approved 106 new accountable care organizations, a critical component of healthcare reform. ACOs are groups of providers in a region that will coordinate patient care with a goal of improving outcomes. Health information exchange and electronic health record interoperability will be critical to ACOs as they share information to improve treatment decisions.
  • The HITECH Act's EHR incentive program has drawn some criticism in recent months. Several Republican members of Congress late last year questioned whether the program's requirements related to health information exchange and interoperability were stringent enough. And a new report from Rand Corp. says that promised cost savings resulting from implementing EHRs has been disappointing so far, in part because of a lack of interconnectivity among EHR systems.

A Top Priority

A top priority for federal regulators should be helping the healthcare industry iron out these health information exchange and interoperability issues. The Office of the National Coordinator for Health IT already has taken some important steps in this direction. But the office still has a lot of work to do, and it cannot afford to procrastinate.

ONC opened the new year by trying to get the message out about the differences between "health information exchange" and "interoperability." In a blog posted Jan. 9, Doug Fridsma, M.D., ONC's chief science officer, wrote: "The words 'interoperability' and 'health Information exchange' are ... often used interchangeably, but I think it's important to realize that they are not the same thing. ... Exchange is necessary for interoperability, but it is not sufficient by itself to achieve health information interoperability."

Fridsma contends that "a full set of standards" that goes beyond standards for data transport is needed to support true interoperability.

In December, ONC's leader, Farzad Mostashari, M.D., revealed in a blog plans to issue incremental, voluntary HIE guidance, for which the goal is to "increase interoperability, decrease the cost and complexity of data exchange and increase trust among participants to mobilize trusted exchange to support patient care."

The decision to offer incremental guidance was a big change from ONC's original strategy of issuing a regulation spelling out voluntary "rules of the road" for national health information exchange (see: ONC Backs Off HIE 'Rules of Road').

Prompt Action Needed

An incremental approach to voluntary HIE guidance is reasonable to help avoid stunting the innovative use of emerging technologies. But the issuance of these guidelines shouldn't be dragged out, which, I fear, is a possibility considering how long it takes the federal government to make decisions.

ONC needs to stay focused on offering these best practice suggestions for secure HIE sooner, rather than later, so that healthcare providers can implement them as both healthcare reform and EHR implementation funded by HITECH continue to advance.

It's also encouraging to see that the Privacy and Security Tiger Team, which advises ONC, is continuing work on important issues, including secure queries and responses. The group just wrapped up recommendations on verifying the identities of patients seeking online access to their records (see: Patient ID Best Practices Coming Soon?). ONC needs to finalize and distribute specific best practices for authentication as soon as possible.

ONC also is hosting online town hall meetings on Jan. 17 and Feb. 14 on the governance of health information exchange that will enable stakeholders to describe key issues, priorities and concerns. Meanwhile, a Jan. 29 public hearing hosted jointly by the HIT Policy Committee and HIT Standards Committee is also slated for the further discussion of key HIE issues.

Arthur Kellerman, chair of policy analysis at Rand and co-author of the new report on EHRs, says ONC needs to provide more leadership to the healthcare industry regarding interoperability and interconnectivity to ensure that maximum cost savings are reaped from the implementations of EHRs. He argues that ONC's guidance should come out well before the start of Stage 2 of the EHR incentive program next year.

"ONC is heading in the right direction, but they've got to go faster and be more decisive," he says.

I share that point of view.

About the Author

Marianne Kolbasuk McGee

Marianne Kolbasuk McGee

Executive Editor, HealthcareInfoSecurity, ISMG

McGee is executive editor of Information Security Media Group's media site. She has about 30 years of IT journalism experience, with a focus on healthcare information technology issues for more than 15 years. Before joining ISMG in 2012, she was a reporter at InformationWeek magazine and news site and played a lead role in the launch of InformationWeek's healthcare IT media site.

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