Health information exchanges in which electronic medical records can be transmitted between providers has been the most challenging requirement to prove meaningful use as spelled out in the HITECH Act. So much so that the Office of National Coordinator for Health IT, part of the Department of Health and Human Services, issued a request for information last week to get ideas that would accelerate electronic health record exchange between providers.
An article published in the Journal of the American Medical Association this week argues that health information exchanges are unworkable and takes the view that cloud-based health record banks are the best way forward.
William Yasnoff, one of the three authors of the article, is the founder and managing partner of National Health Information Infrastructure — a consulting firm that helps communities and organizations develop health information infrastructure systems and is a member of the Health Record Banking Alliance. He says if electronic health records are banked in communities around the country, it would create a more scalable way for patients to share their information that makes sense. He compares the idea to credit reports that can be updated by each bank that receives (or doesn’t receive) monthly credit card payments from consumers. Patients’ electronic health records would be maintained in cloud-based banks in communities across the country although their local provider would have their own copy. If you move, you could have your records transferred to a bank that’s more convenient.
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The request for information stated the ONC is seeking input “on a series of potential policy and programmatic changes to accelerate electronic health information exchange across providers as well as new ideas that would be both effective and feasible to implement. To further accelerate and advance interoperability and health information exchange beyond what is currently being done through ONC programs and the EHR Incentive Program, HHS is considering a number of policy levers using existing authorities and programs.” It listed April 21 as the cut-off date for proposals.
“The problem is we have a crisis in healthcare and we need electronic records to improve quality and reduce cost and to effectively reform [the] system and to monitor what reforms we’re doing so we are not causing harm, so it is extremely urgent that we do this right,” observed Yasnoff in an interview with MedCity News. “The ONC has essentially admitted defeat.”
Yasnoff said he is not opposed to the idea of health information exchanges, but the way they are currently structured is faulty. Ultimately patients should be in control of the health records. He pointed out that health information banks could be joined up with the Blue Button initiative, particularly the mobile Blue Button solution.
Yasnoff highlighted several health banks in operation. In the U.S., Microsoft runs one called Health Vault; Washington state has been conducting pilot programs. Oregon has set one up too. There is also a consortium of a practices called Dossia. Outside the U.S., there are health record banks in the UK, Germany and in Australia. They have not been without their own set of problems, particularly in Australia where the shift to an electronic record system has created a lot of anxiety and is experiencing growing pains.
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The problem with health information exchanges in their current form, says Yasnoff, is that they make the assumption that you can get information about any one patient from any provider whenever you want it. But when you go to a hospital and it needs to contact another provider to have the patient’s records sent, you think of it as just pushing a button and it’s transmitted electronically. “But then if you think in that kind of system, every organization has to be able to talk to every other organization where the patient has received treatment. Each one has to do a search for the patient’s information and it’s inefficient”
The Direct Project has helped providers set up secure emails to send requests for prescriptions and tests to honor the goals of the meaningful use provisions spelled out in the HITECH Act. But providers have also been reticent about exchanging patient information. There is also the great interoperability problem between providers using different electronic health record vendors, which was a significant focus of the HIMSS conference. In a proposal to both ease the problem and to make them more competitive with market leader Epic, a group of health IT vendors led by McKesson and Cerner formed the CommonWell Alliance to create a better way to track patients in the system
How will health record banks be monetized? Yasnoff said there could be a range of accounts from basic accounts that would be free and would be financed by accounts that had extra level of service such as apps that would be relevant to their needs. He suggested having convenience apps such as letting loved ones know if you have been admitted to the hospital for an emergency or loved ones could get it on your behalf. Account holders could also pay extra to be notified of clinical trials.
Yasnoff’s argument that health record banking would put more control of patient records in consumer hands will resonate with supporters of the e-patient initiative. But the amount of investment that has already been allocated to building health information exchanges would be difficult to simply give up and walk away. We seem to be at a crossroads for figuring out the best way to share patient information and it will be interesting to see where we are come late April.