Tuesday, February 14, 2012

HIEs Progress and Challenges

“Health Information Exchanges have made progress but challenges and barriers still exist in dealing with this complex issue,” according to Darrell West Vice President and Director of Governance Studies and Founding Director of the Center for Technology Innovation at Brookings. On February 8th, he moderated a panel discussion on the issues surrounding the implementation of health information exchanges.

Claudia Williams, Director State Health Information Exchanges in the Office of the National Coordinator reports that there is good news and bad news on exchanges but in either case, exchanges are ready to take off.

According to Williams, progress is taking place with increases in meaningful use, doubling of
e-prescribing, conversations with consumers, developing consumer portals, and looking at innovative plans and ideas for payment reforms. There is a great interest in exchanges, however, dialogue and conversation needs to take place on developing workable business models so that costs are lower. The answer may be to knit together existing HIEs in order to reduce the cost of exchanges.

“This country needs to move towards accountable coordinated care but we won’t be able to get there unless health exchanges are established”, according to Janet Marchibroda, Chair, Health Information Technology Initiative at the Bipartisan Policy Center.” Further work needs to be done on governance, payment issues, further work on standards, adoption, and dealing with issues on the ownership of medical information, privacy, security, and workforce issues.”

AHRQ has and is still playing a role in doing evidence-based research on HIEs. Initially, AHRQ funded demonstrations in different states and made an initial investment. The states that were funded years ago are now serving as models, according to Jon White MD, Director for the Health IT Portfolio at AHRQ. He said, “Establishing HIEs is harder than people thought it would be because it is not just about equipment but most importantly exchanges are about people”.

John Piescik, Strategy Program Manager at the MITRE Corporation reviewed made an important contribution by examining relevant MITRE research. His team looked at ways to enable large scale organizational changes to take place across organizational boundaries.

Also, on February 8th, Allan Friedman a Fellow in Governance Studies and Research Director of the Center for Technology Innovation at Brookings, along with Darrell West released the paper “Health Information Exchanges and Megachange.”

Specific state experiences were researched in the states of Indiana, Massachusetts, New York, Tennessee and California. The authors summed up the progress in these states related to exchanges and found a wide range of approaches, tactics, and outcomes. In general, Indiana and Massachusetts have made significant progress, New York has made moderate progress, and Tennessee and California have made limited progress implementing HIEs.

The paper also discusses the challenges and lessons learned for developing and operating HIEs. One issue is how to deal with the funding uncertainty at the state and federal levels in order to maintain support over time. The paper points out that some states have made efforts to find alternative revenue sources.

Another issues concerns federal health policy as to whether it should just be centered on state-level exchanges. However, some observers are questioning this approach. Marc Overhage, Chief Medical Informatics Officer at Siemens and previously the President of the Indiana HIE, maintains that the state may be the wrong unit to move HIEs. So in some respects, disagreements over federal policies have stymied progress on HIEs.

The authors also see the need for varied approaches since no one approach will work in every place. Each state has to identify its own strengths and build their HIE in a way that will work in their state and location.

Go to www.brookings.edu/events/2012/0208_health_information_exchanges.aspx to view a podcast of the event. To download the paper, go to www.brookings.edu.