I recently came upon some unsettling information about the current state of HIEs (Health Information Exchanges). It was disturbing in light of the increasingly important role that interoperability plays in healthcare and because expectations are already being placed on many physicians regarding clinical data exchange. Much is written about the problems that HIEs face—the challenges most commonly being attributed to funding, business sustainability, and, in a recent post, insufficient EHR penetration. But what I discovered in conversations with a major HIE reveals an even bigger shortcoming.
A nationally known hospital system in a major metropolitan area has implemented an HIE operated by one of the biggest names in the world of health information exchange. One would expect this large company to be on the forefront of this emerging area of technology. However, this HIE vendor is incapable of accepting clinical data in the current, standard format (CCD—Continuity of Care Document), despite the fact that CCD has been recognized as the “new” standard since 2008. CCD was selected by the Healthcare Information Technology Standards Panel (HITSP), recognized by the Secretary of HHS, and named as the standard for clinical data exchange in the Meaningful Use regulations. This major HIE told us that CCD is “on their development roadmap,” and that they currently accept clinical data only in HL7 format.
The problem this creates is that, once again, physicians are left holding the bag! At this particular hospital, many of the independent physicians are members of an organization that represents their interests. They are implementing EHRs—which is a good thing—and are expected to participate in the HIE and to exchange data by the end of this year. However, their respective EHR vendors will have to maintain multiple standards to satisfy all of the various participants, and this will incur higher costs, which will ultimately be borne by the physicians.
How can we expect true sharing of data when not all parties that participate in information sharing are being held to the same standards—standards that have been established specifically for this purpose? Perhaps HIEs should be regulated to ensure compliance, just as EHRs and the physicians who implement them are.