There’s good news and bad news in a HIMSS progress report on Health Information Exchanges published this week. The good news is the percentage of healthcare facilities participating in these exchanges has grown in the past five years from 14 percent in 2008 to 30 percent in April 2013. The bad news is budget and technology constraints coupled with concerns over sharing data by hospitals is limiting their effectiveness.
About 158 responded to the survey, just over half are chief information officers. Most represent medium and large healthcare facilities. These were the top five challenges to sharing data within exchanges:
- Other organizations are not robustly sharing data 49 percent
- Constrained by staffing resources 43 percent
- Constrained by budget limitations 39 percent
- Concerned about privacy/security of shared electronic data 38 percent
- Constrained by technological offerings in the market 23 percent
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About 73 percent of respondents said they participate in a health information organization (aka HIEs). More than half only participate in one of these exchanges and the public exchanges dominate, accounting for 57 percent of these networks.
Most respondents, 76 percent, use one health IT company to meet their electronic medical record requirements, another 20 percent use multiple vendors, taking a best of breed approach. But despite having these different levels of complexity, about 60 percent have found it challenging to manage these relationships. Although it’s disappointing it’s not surprising. A report presented at the annual HIMSS conference earlier this year highlighted delays health information exchanges have faced because health IT vendors are so busy helping health care facilities either convert to electronic medical records or upgrade them to meet Meaningful Use requirements.
Most health information exchanges use a portal or point-to-point/Direct format to facilitate the exchange of information between hospitals. Although faxing is still the dominant way hospitals share information if they’re not in the same exchange (64 percent), it is just one method of doing this. They may also transmit data point-to-point — one hospital at a time (46 percent), or through a portal — (39 percent).
The report emphasized that as long as healthcare facilities continue to use paper it’s important to be able to scan these documents to ensure they can more easily exchange this data with other hospitals inside and outside the exchange.
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A strong output/print strategy ensures that documents of all types — lab results, consent forms, physician notes, etc. – can be scanned and archived, or distributed to the appropriate complimentary technology, the report said..Many respondents indicated that their output/print environment was not a high priority in their organization’s strategic plan, which challenged their ability to create a desirable output/print environment that can continue to facilitate the effective exchange of information.
Those expecting significant changes in the development of health information exchanges would be a bit disappointed by the findings of the HIMSS report. There has been progress in getting providers to participate in exchanges, mostly through the federal grant program — the Direct Project — that has helped many states set up a basic HIPAA-compliant format for sharing patient data. But the reluctance to share patient data is worth exploring. Is it all about reducing security risks, which accounted for at least a portion of the responses? With the increased penalties hospitals face over protected health information breaches, it’s not likely to make risk averse institutions less so. Or is it about competition or are there other factors?
I would like to see a report that goes deeper to exploring these questions. Budgetary constraints may slow down participation and in these exchanges, but hopefully the challenges won’t obscure the long-term benefits of sharing information to improve patient safety. Ultimately, the more healthcare facilities that participate and best practices that can be shared and promoted will help make these exchanges more useful and increase their perceived value.
[Photo from Flickr user Jerryjohn]
