The Office of the National Coordinator for Health IT hopes to see “really rapid progress” this year on the building blocks that will promote health information exchange, such as provider directories, certificates to assure identification and rules of the road for the nationwide health information (NwHIN) Exchange.

Health information exchange (HIE) will need a variety of models to be able to scale up sharing among physicians, hospitals, and patients and across care settings as called for in the meaningful use Stage 2 proposed rule. Over the years, ONC has considered a national architecture of regional health information organizations (RHIOs) and most recently a large role by single statewide HIEs.

[See also: Interoperability failure causes headaches for Maine Medicaid]

Farzad Mostashari, the national health IT coordinator, said health information exchange will not become a reality as a single vision or system but instead include many models and business plans.

“It’s going to be a little messy but very liquid and fluid, where there will be lots of different means for information to go where it needs to go. The vision we have is around standards, around directories, and a whole host of different ways that information can be shared and understood,” he said at the March 7 meeting of the advisory Health IT Policy Committee.

In his keynote at HIMSS12 Mostashari told the audience he viewed HIE as a verb, not a noun.

Although private information exchanges have grown and health IT vendors are enabling large networks, like Surescripts e-prescribing network, sharing health data among providers for care coordination is not happening yet, said Claudia Williams, director of ONC’s state HIE program.

[See also: Q&A with AAFP's Steven Waldren on meaningful use]

Surveys have shown that about 73 percent of the time primary care providers don’t get discharge information within two days. And only about 20 percent of hospitals have a mechanism in place to share clinical information electronically with other providers outside their system.

“We can’t wait. We have to have actual change occurring in Stage 2,” she said.

“When you look at the bread and butter to support care transitions, we need a way that is ubiquitous that when you refer someone, discharge or send a lab result, that information goes to the next point of care,” she said, adding that is a goal for this year. Williams also has an article published in Health Affairs' March issue that oulined ONC's HIE architecture strategy.

ONC’s role is to put those building blocks in place to reduce providers’ burden and cost through identifying standards, finding ways to support positive market developments, and jump starting needed services for an HIE program so that, for example, $10,000 lab interfaces can be decreased to as low as possible, Williams said.

In Stage 1, the foundation was laid with standard vocabularies, code sets and content structure so that EHRs could produce data that could be understandable and incorporated into another provider’s EHR.

Since then, two common approaches have become available to transport patient data with Direct secure messaging protocols on a one-to-one basis, and NwHIN Exchange’s more comprehensive standards and services for sharing with many, and electronic data standards for care transitions has been whittled down to one.

ONC is focusing on the next set of building blocks to accelerate health information exchange, including:

• Directories to look up providers or maintain a list of providers in a way that others can find the information, including figuring the data elements needed to query or to open up a directory
• Digital certificate management and discovery to support Direct to establish identify and authentication and to make the public keys findable
• Governance or a common set of rules of the road to build trusted exchange and to make the NwHIN Exchange more scalable.

The state HIE program may evolve from building a single network in a state to starting up needed services to support providers to exchange, Williams said. For example, in California, there are 19 exchange networks, some well-established and some not.

“The challenge is to attract investment so they can all move forward together in a way that protects patient privacy and allows for exchange, and that exchange can occur across networks,” she said.

Later this month, five states will start consumer data-sharing efforts for the next six months around immunization records, sharing their HIE data, and figuring a way to take repository information and do a patient match into a PHR, Williams said.

[See also: Wide open future]