The stars seem to be aligned for rapid progress in health information exchange. We are fast approaching a point in the development of the Health Internet where ubiquitous exchange of health data to improve care coordination and health care quality and ultimately lower costs might be possible. We still face some problems, and standards and policies must be aligned, but there is some great synergy in play that will help drive this vision forward. There are a variety of different initiatives which are coalescing, but there is also a great deal of work still left to do.

HIE Efforts Under Way

The Nationwide Health Information Network Exchange (now called the eHealth Exchange) has successfully transitioned to an independently sustainable public-private partnership. This new organization, called HealtheWay, includes four federal agencies -- CMS, the Department of Defense, the Social Security Administration and the Department of Veterans Affairs -- as well as at least 21 non-federal entities that all share patient records for episodes of care. The ability to provide a platform for national exchange is critical to the success of efforts to reach the triple aim of improving the experience of care, boosting the health of populations and reducing per capita costs of health care. By ensuring that clinicians have the right information at the right place at the right time, we can finally begin to make progress in achieving these goals.

Working in tandem with the transition to HealtheWay have been collaborative efforts fostered by the EHR/HIE Interoperability Workgroup (IWG). One objective of IWG has been to define a single set of standardized, easy-to-implement interoperability specifications that will increase the adoption of electronic health records and HIE services. Formed by the New York eHealth Collaborative, IWG is comprised of several vendors and organizations, as well as seven states:

    California;

    Colorado;

    Maryland;

    Massachusetts;

    New Jersey;

    New York; and

    Oregon.

This represents approximately 30% of the U.S. patient population. IWG has joined forces with HealtheWay to enlist the Certification Commission for Health Information Technology (CCHIT) to work on an HIE testing program to ensure they are capable of exchanging standardized content using a specified transport mechanism. CCHIT will employ Aegis, which has a long history with the NwHIN Exchange, to provide a cloud-based testing environment in which vendors can prepare to have their systems tested on a variety of use cases. If the initiative is successful, it will provide a type of plug-and-play connectivity between EHRs and HIEs and between HIEs themselves, which will lessen the need for interfaces between systems.