ONC webinar: State HIE efforts turning a corner in 2012

Claudia Williams, MS, director of the Office of the National Coordinator for Health IT’s (ONC) state health information exchange (HIE) program, offered a review of the ONC’s progress on HIE and its primary goals for 2012 during the National eHealth Collaborative's webinar on “ONC’s National HIE Strategy.”

“We're on the verge of turning the corner on HIE," she said. "The building blocks put in place by the HITECH Act help everyone see where exchange fits into the broader set of goals we all share. We've made incredible progress in a short amount of time. Information exchange should take off in 2012."

The agency plans to modernize the U.S. healthcare system through health IT by accelerating meaningful use (MU), protecting privacy and security, keeping patients safe, promoting exchange, engaging consumers and showing outcomes, Williams said.

The current health IT environment poses several challenges, including:

• Little exchange is occurring. In fact, Williams said 27 percent of hospital discharge summaries get to primary care providers within 48 hours.
• The cost of exchange is high, while the time to develop is long. Despite the relatively low volume of information exchange, the cost is “often higher than we would like.”
• HIE is poised to grow rapidly, spurred by new payment approaches. MU and consumer engagement are driving that growth, she said. Seventy percent of hospitals plan to invest in HIE services in 2012, she said.
• There are many approaches and models for HIE.

Changing expectations of healthcare professionals as well as patients is happening, said Williams, and “we hope and expect that to increase.” For example, most consumers expect e-prescribing.

The ONC has a goal that information securely follows patients whenever and wherever they seek care, she said. “That’s an easy statement to make but it takes hard work. There are multiple ways of getting there.”

The models currently in use include query-based exchange where a provider finds patient information to support unplanned care; directed where patient information is sent and received to support care coordination; and consumer-mediated exchange where patients aggregate, use and share their own information.

“We are looking to put in place building blocks that will enable multiple models of exchange to flourish and meet the needs of patients and providers,” said Williams, adding that the agency does not expect one solution or architecture to fit all markets. “Multiple approaches will fit side by side. We want to enable all of those approaches to thrive.”

ONC’s approach to furthering information exchange includes several mantras. For example, government needs to be leveraged as a platform to create innovations for conditions of interoperability, HIE is not one-size-fits-all; and interoperability is a journey, not a destination. “We’re not going to be done this year or next year,” said Williams, adding that HIE will continue to evolve as users learn the best way to do things.

The ONC has four key areas in which its driving progress in 2012, said Williams, helping its role to drive down costs while driving up trust and value.

1. More rigorous exchange requirements in MU Stage 2 to support better care coordination. Getting every provider to participate in the electronic exchange of information for care transition is a “hallmark next step for MU,” she said. “What’s exciting is how this can build on important standards work we’ve already done.” The proposed rule for Stage 2 “sets the stage for the kind of rapid progress and exchange we need and what we want to see over the next couple of years.”
2. Additional standards work. The ONC is working toward more consistency in how information is recorded. “This year, we plan to address missing components to support scalable exchange,” she said, which includes directories, certificate management and discovery and governance. A baseline set of standards and policies will accelerate exchange by assuring trust and reducing the cost and burden of negotiations among exchange participants, she said. Williams is excited that we now have two easily adopted standards for transporting information – NwHIN Direct and the transport protocol used in NwHIN Exchange, as well as the fact that the nation for the first time has a single, broadly-supported electronic data standard for patient care transitions.
3. Governance for NwHIN. Expect the release of a proposed rule in this very soon, she said. In the absence of national guidance for privacy and security, states and private organizations have developed their own technologies. “We’d much rather have national guidance and put in place conditions that allow for a competitive marketplace, just as with EHRs.” ONC also hopes to reduce the costs and complexity of business agreements.
4. Jump start the state HIE program through services and policies. Every state is different so there cannot be a cookie cutter approach, she said. “There are a wide variety of strategies depending on what’s already in place and what kind of rapid progress is possible in a particular area.” The agency is focusing on giving providers viable options to meet MU exchange requirements, such as e-prescribing, care summary exchange, lab results exchange, public health reporting and patient engagement. ONC will do this by building on existing assets and private sector investments, she said.

Future challenges include automation of care coordination tasks, connecting exchange nodes, filtering and searching, liability and patient matching. Patient matching is a pain point for a lot of providers, Williams said. While some are advocating for patient identifiers, she said ONC also thinks that, in addition to those kinds of solutions, data quality on demographics will play a role. That requires determining which algorithms are best for patient matching and interoperability challenges.

“There is a lot of basic meat and potatoes work to be done in this area,” Williams concluded.