Health Affairs: ONC outlines HIE goals for 2012
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"These will include establishing common rules for exchanging information through governance, developing an approach to manage and discover security certificates (used to identify and verify users) and specifying standards and policies to discover and query provider directories,” wrote the authors, including Claudia Williams, ONC's director of the state HIE program, Farzad Mostashari, MD, the national coordinator for health IT, Kory Mertz, ONC's challenge grant director, Emily Hogin and Parmeeth Atwal--both from the ONC's office of communications. “The focus on the adoption and use of a few core standards and policies will ensure that information can truly follow patients as they move across the healthcare system and that the cost and complexity of exchange is reduced.”
The authors stated that electronic HIE addresses a critical need in the U.S. healthcare system to have information follow patients to support patient care. However, the authors cited a 2009 Commonwealth Fund International Health Policy Survey that found 73 percent of the time, primary care providers in the U.S. do not receive discharge information from hospitals within two days of their patients’ discharge.
Additionally, “the lack of widely adopted standards, failure to use existing standards, and flexibility in the way that standards are implemented have all contributed to the high cost of exchange,” wrote the authors.
The authors stated the ONC will address three gaps to advance and scale forms of exchange (query-based, consumer-mediated and directed exchange) across organizational and vendor boundaries:
- Closing three gaps in the advancement of exchanges: These gaps include provider directories, certificate discovery and management and governance.
- Enabling every provider to send and receive patient data electronically: “This year’s initiatives will build on the Direct Project model of tackling specific problems by engaging implementers—including vendors and providers—in developing, testing and adopting workable solutions.”
- Supporting the development and spread of information exchange capabilities: The ONC is working with public- and private-sector stakeholders to establish policy recommendations for these key issues that could be implemented through a variety of mechanisms. Those mechanisms include Nationwide Health Information Network governance rules, the health IT certification program, and guidance to the office’s grant program recipients.
- Enabling consumers to aggregate, use and share information: “Consumer identity services are needed beyond the realm of healthcare for other government and private services. Therefore, a broad-based, market-oriented approach may be preferable and more efficient than a strategy narrowly focused on health information.”
However, the authors noted this would be no cake walk. Challenges such as patient matching, connecting exchange nodes and tracking sources of information will need to be addressed.
“The growth and spread of query-based exchange will be supported by advancing the policy, technical and governance requirements to support phased, modular development of exchange capabilities that allow providers to find information on a patient,” the authors concluded. “The ONC will work with federal partners to expand patients’ access to their own data and tackle the policy, implementation and technical issues to support consumer-mediated exchange.”