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Health information exchanges need work, says ONC official

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There are a few pockets of successful health information exchanges nationwide--arrangements designed to share data, enhance communications and integrate health provider networks as part of healthcare reform efforts--but by and large "we're not in great shape," said a Health and Human Services Department official.

"Even the most basic care coordination tasks, like getting a discharge summary when your patient is discharged...about a quarter of the time that occurs within 2 days and almost never electronically," said Claudia Williams, director of state health information exchange within the HHS's office of the national coordinator for health information technology. Williams spoke Feb. 8 during a Brookings Institution event in Washington, D.C.

Only about 19 percent of hospitals have a mechanism to share clinical information outside of their own system, added Williams. E-prescribing has doubled in just one year, however. Williams said with stage 2 of meaningful use rules set to be released "in the next month or so," ONC is hoping to see adoption rapidly increase.

Standards drive adoption, said Williams; there are now standardized ways to report medications, record information and vocabulary and content standards for all electronic health record information. Still, more needs to be done, said Janet Marchibroda, chair of the health information technology initiative at the Bipartisan Policy Center.

"We need to get a little further on standards--whether they're data transport standards, data content standards, more easy-to-use guides--in order to apply those standards. So you don't need to be a big, integrated delivery system in order to make those standards work," said Marchibroda.

But even when the technical standards are in place, the largest barrier to adoption is sometimes the business model, said Williams.

"Business models that gain value from retaining and capturing and not sharing information, there's always going to be a reason not to reduce cost, there's always going to be a reason not to adopt standards," said Williams.

In the next year ONC wants to have an "open conversation" on business models that reward sharing and encourage change, said Williams. In the coming months the office will put forth governance policies through regulation that will establish common interoperability and trust requirements that may help encourage sharing, she added.

Even some of the communities that have invested heavily in information sharing are struggling to drive adoption, said Williams.

"So, if you have the capacity to look up a patient record, when should you do that? And what should you be looking for and how do you use that information? Should you not do another radiology test if one has already been done? When you refer a patient, how exactly should you send along the information?" asked Williams.

In the next 12 months, ONC hopes to have "a much more granular conversation," on using health IT at the care-delivery level, she said.

For more:
- go to the event page with archived audio

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