Panel: Standards needed to advance HIE

In a panel discussion on health information exchange during the Centers for Medicare & Medicaid Services’ eHealth Summit, one participant pointed out the importance of realizing these are culture transformation projects. Leaders must “not just watch milestones go by” but foster real engagement and transformation of organizations and cultures, said Hunt Blair, principal advisor of state HIT-enabled care transformation for the Office of the National Coordinator of Health IT.

“The real win here is that people are beginning to understand that in order to tackle something as complex as this, it really takes a lot of considered effort and collaboration,” he added. “It doesn’t just happen accidentally. The benefit of the challenges is that there has been a lot of learning. People now have the education we all wish we’d had a number of years ago.”

Governmental regulations and funding have largely driven the healthcare reform currently underway. “Regulatory apparatus is an important structure for government to use to put funds in and make sure those funds are well spent but it’s not the most nimble of structures,” Blair said. “It’s not an easy task what we’re trying to do. This is incredibly disruptive.” He said medicine really is the last cottage industry—the last to move to full interoperable digitization. “We’re only at the beginning of understanding the benefits. The work is hard and it takes time. We’re really just now getting the kinds of motivating structures out in the community around various payment and delivery system reforms. Healthcare reform is happening on the ground as we speak.” 

Healthcare can’t be practiced the way it used to, said Marty Rice, senior advisor, Office of Rural Health Policy, Health Resources & Services Administration. Twenty percent of healthcare in this country is in rural areas but only 9 percent of physicians are in those areas. “We need something to bridge this gap between the geographic barriers we have,” Rice said. Many rural clinics lack the ability to do so because of the lack of access to broadband.

Building that bridge is challenging even in more populated areas. Tyler Carruth, state health IT coordinator, Louisiana Department of Health and Hospitals, said progress has been slow. “Providers are not looking to be the guinea pig. The bleeding edge can be painful. Adoption is gradual.” Progress, however, appears to be picking up—he said that the statewide HIE had five hospitals at the beginning of this year but plans to have 35 signed up by the end of this month.

Meanwhile, “we’re definitely seeing some challenges around connectivity,” said Rachael Williams, assistant program manager, North Carolina Division of Medical Assistance of the state’s Department of Health and Human Services. Her group is trying to break down the barriers that are strategically placed around HIE in the state, she said. “Everyone understands the value of having access to data but they want to control access to their own data.” Plus, she said everyone is so focused on implementing EHR technology right now that they “can’t even think about connecting up to the HIE yet. We’re trying to get them over that first step so they can focus on the second.”

Health IT is becoming the new norm, said Rice. “We’re listening to our providers when we ask what they need from us to adopt technology to make their jobs easier to provide more care, safer care at a lower cost.”

Patient engagement is an important part of information exchange, the panelists agreed. The short-term goal is building critical mass, said Carruth, and connecting rural areas to metropolitan hubs. Looking forward, “we need to reach out and find new ways to engage consumers to get them involved in their healthcare rather than be passive members.”

“We use telemedicine and telehealth interchangeably now,” said Rice. “You really can’t separate the two.” Despite that growth, both patients and providers need to increase their comfort level, he said. “We need to start empowering patients so they feel comfortable with these remote services and also empower physicians to feel more comfortable about treating patients remotely.”

When asked what the federal government can do to help with their organizations’ goals, the panelists focused on standards.

“One of the biggest challenges is getting standards in place,” said Williams. For example, she said vendors are implementing continuity of care documents in different ways. “That affects the time it takes to connect a provider through the HIE. It’s hard to come up with standardized pricing if everything looks different. As the federal government pushes HIE and [creates] those protocols, it would help us at a state level come up with cost strategies we can rely on.”

The need for standards goes beyond EHR adoption, said Carruth, citing the ability to submit information such as tumor registry data in a standardized way. “We’ve seen cases where we have vendor delays due to having to configure their system. It’s not just adoption—the lag is the ability of vendors to customize and integrate.”

Most of the activity around health IT has been a big experiment, said Blair. “It’s not easy to have things go wrong. We all have to invest a little vision in the fact that it’s going to take some time to work through this.”