National Health Information Exchange: Why The Delay?

From November 5, 2012 article on

Hurricane Sandy took many lives and caused billions of dollars in damage. But so does a healthcare system that still refuses to embrace interoperability.

There’s nothing like a common enemy or problem to bring people together. In the days since Hurricane Sandy, we’ve witnessed countless acts of heroism and generosity in the face of destruction and despair. It’s a pity Americans can’t bring that same sense of common purpose to health information exchanges.

Many would argue that the immediate threat and aftermath of a storm far outweigh the negative consequences of a poor system for sharing patient data. But that’s an illusion. Some 50 people died in Hurricane Sandy, but more patients die each day as a result of poor communication among clinicians and inadequate exchange of data during transitions from hospitals to nursing homes and rehab facilities.

When Mr. Suarez, suffering from congestive heart failure, is discharged from a hospital to a nursing home, the nursing home staff can make any number of life-threatening mistakes if they don’t have the necessary details on his medications, allergies, diet restrictions, and cognitive abilities. Multiply that potentially lethal situation by all of the hospital discharges nationwide each year, and you have the makings of a perfect storm.

So given the urgency, what are we waiting for? At last week’s Connected Health symposium in Boston, Dr. David Blumenthal, the CIO at Partners Healthcare and former head of the Office of the National Coordinator (ONC) for Health IT, addressed some of the issues. During a presentation on how to create an effective national HIE, he described it as a “sociotechnical project that has technical aspects as well as enormous political, economic and social aspects.”

Among the political issues to contend with is a contingent of Congressional naysayers who would like to dismantle Meaningful Use, one of the most important measures to promote widespread EHR adoption. Obviously, we can’t exchange healthcare data nationwide if providers don’t have that data in an electronic system.

MU Stage 2 is slowly moving providers further down the path toward interoperability. It’s being accomplished by insisting that at least 10% of patient data be transmitted “down the line” during any kind of transition from one care setting to another. It’s a small step, but nevertheless a place to start.

Blumenthal also placed a great deal of emphasis on putting technical standards in place so that providers can share information more easily. ONC has made major strides in this arena, and more is to come.

A public-private consortium is putting in place a system that should provide interoperability among disparate EHR systems and HIEs. If it’s successful, it will provide plug-and-play connectivity between EHRs and HIEs and between HIEs. This initiative would drastically cut the expense of interfaces and would let more than half of the U.S population and their healthcare providers access health data shared among multiple states and systems.

Healtheway, the new private-sector entity that operates the eHealth Exchange (successor to the Nationwide Health Information Network), has partnered with a consortium of states, EHR vendors, and HIE vendors to implement standards that will make it easier to exchange health information.

Despite this progress, there’s at least one issue no one wants to touch: the individual patient identifier code.

I’ve spoken to several CIOs at large healthcare systems who have spent serious money creating master patient indexes that try to figure out if, for example, John Miller and John J. Miller are the same patient. All that work could be eliminated if each patient entering the U.S. healthcare system had the equivalent of a social security number. But whenever that proposal comes up on the national scene, we hear critics shout socialism for fear that such a numbering system brings us one step closer to a government-run healthcare system.

The sad truth about Hurricane Sandy is that the heroism seen during and after the storm in some cases quickly devolved into self-absorption as commuters fought over scarce gasoline and other essentials. Let’s hope the nation’s healthcare policy-makers and IT stakeholders don’t succumb to the same kind of small-minded bickering.