When William Yasnoff, MD, president of the Health Record Banking Alliance (HRBA), declared that "our nationwide network of health information exchanges is an unmitigated disaster" in a NHINWatch Perspective column last month, his assessment that HIEs are failing became a hot topic of discussion. Critics and supporters weighed in. Farzad Mostashari, MD, national health IT coordinator, emphasized the return on investment of current HIEs at the Jan. 29 joint meeting of the federal advisory Health IT Policy and Standards committees.

[See also: A failure of information exchange?.] and [Nation's eHealth Exchange stands up]

As the debate continues, Irene Koch, executive director of the Brooklyn Health Information Exchange (BHIX), points out, "Evolution is still happening with all of the systems and the standards." Provider buy-in and a commitment to care coordination from all stakeholders (patient, provider and payer), which is critical to making health information exchange successful, regardless of model, are also in the early stages of development, she said.

From the very beginning, New York State has thought through standardization of privacy policies and technical standards, though the complexity complicates advancement. "It does take a while, but I think there's a cognizance that we're working through very complicated issues," she acknowledged. Policy and governance have understandably slowed down the nationwide network efforts as well; however, Koch emphasized that HIE cannot proceed without these key components in place.

Multiple models co-existing

New York State hosts multiple operating models – public HIEs, private healthcare organizations and robust EHR systems – and many are working together. An example is the Medicaid Health Home program, which is run by the New York State Department of Health. Participating provider organizations or a group of healthcare organizations may have their own application, but that application is also required to connect to the regional HIE and statewide HIE. Common principles of consent, governance, responsibility and technology have enabled this ecosystem. With this ecosystem in place much work still needs to be done, Koch noted, "It is really too early to say that there's one solution that will fit everyone’s needs."

[See also: NYeC's 'public utility' model works well for regional HIEs.]

The Medicaid Home Health program also involves another key component for HIE success – payer participation and buy in. The program is a "good prototype" of how the regional HIE and statewide HIE system has been evolving and working closely with private systems that are working with the payer – in this case, Medicaid – to improve patient care. "That's music to our ears; that's the kind of working together that's going to allow patient-centered health information exchange to take hold," Koch said. The program is working through workflow issues and determining how to leverage technology to support these models of care. "This is the nature of the working lab," Koch said.

At this point, BHIX is focused on educating its providers, who in turn are working with their patients to understand how health information exchange can help providers improve patient care and help patients understand how they can have buy-in into the system and consent to share their data. "Without all of these things working at the same time, you just don’t have a system that will succeed," she explained.