Interoperability hearing: Speakers call for trust, standards and 'address book'

Provider, vendor and patient stakeholders shared thoughts on health information exchange and interoperability during an Aug. 15 hearing held by the governance subgroup for the Health IT Policy Committee's Interoperability and Health Information Exchange Workgroup.

As in many discussions and debates on the topic of interoperability, the speakers pointed to the lack of common standards as the primary barrier. While most said they are using Direct messaging, Greg Wolverton, CIO of ARcare, said there are unique challenges surrounding each use case which “comes down to not having clear-cut methods or standard methods to disseminate data in a streamlined manner. There are different requirements in each state.”

Henry Wei, MD, senior medical director of clinical innovation for Aetna, said many providers are still using fax machines to share patient information. “Huge volumes of clinical data are moving back and forth to health insurers.” He compared the current, convoluted methods for moving clinical documentation to “putting a burrito inside a pizza. You can eat it but it’s an unusual combination.”

Wei also noted the need to solve for patient-mediated health information exchange. “The health literacy of patients needs to be supercharged.”

Carl Dvorak, COO of Epic, called for a Meaningful Use phone book for which anyone who has received incentive money must register. “Within 12-18 months, we would have an ATM for healthcare. Fewer standards always help a situation like this. Stick with Direct and Connect and focus on excellence on those before new things.”

Healthcare needs to consider more than hospitals. “Most nonhospital providers are using EHR products not capable of bidirectional exchange,” said Morgan Honea, executive director of the Colorado Regional Health Information Organization, a nonprofit public HIE. He said he’s heard price quotes of more than $10,000 to build connections. “Upfront and recurring costs by HIE vendors is the most significant barrier. This barrier affects the small and rural providers much more significantly and those are the ones that could benefit from HIE the most.”

While several participants called for a Direct messaging address book, Honea said there are better ways to facilitate information exchange than Direct. That’s because setting up Direct accounts causes duplicate data exchange efforts, which puts a “strain on resources that could have gone to better patient care.”

On the topic of whether the Office of the National Coordinator for Health IT (ONC) should monitor the HIE market, Honea said this most significant need is to ensure that EHR vendors incorporate appropriate exchange capabilities.

“I worry that, in today’s world, HIEs and HISPs are becoming walled gardens,” said Dvorak. “Immunization registries are being held hostage by HIEs who ask for money simply to gain access to the HIE even if they don’t need to exchange information through it. That’s a problem we should take a look at.”

Establishing connections among providers, researchers, registries and other entities “is extremely expensive, difficult and time-intensive work,” said Tim Burdick, MD, CMIO of OCHIN, Oregon’s health IT extension center. “We favor strong CMS and ONC incentives that would incentivize states, counties and payers to align work around HIE.”

Meanwhile, the backlog for Meaningful Use Stage 2 certification has reduced the number of available exchange partners, said Luis Maas, chief technology officer of EMR Direct. “The inefficiencies in testing are unfortunate. More streamlined testing could accommodate more entities.”

The speakers also discussed the need to improve trust among stakeholders. Maas said trust and policy requirements are ultimately determined by the organizations using the services. He said he and his company support the concept of trust communities to define and optimally enforce HIE, leverage scalable tools and encourage customers to review established trust communities to determine which are suitable to their needs.