According to the report, state-level HIE efforts have taken hold but more direction will be needed to ultimately weave together a network of networks.

According to Kolodner, any nationwide interoperable health information exchange should include privacy as a foundation, along with standards in healthcare IT products and IT adoption.

Kolodner recognized that barriers to adoption include misalignment of incentives, doubts in small physician practices about the quality of electronic health records, lack of interoperability, required workflow changes and lack of an adequately skilled national workforce.

ONC is working to provide solutions that include the certification of products to ease doubts.

By summer 2008 ONC will have orchestrated the development of 30 standards with current certification of  90 electronic health record products, comprising more than 40 percent of the market, Kolodner said.

Privacy activist Deborah Peel, MD, founder of Patient Privacy Rights said she is not surprised that regional health information exchange isn’t working. The RHIO business model requires that hospitals, insurers and employers exchange patient health information without consent from patients. “None of these corporations trust the others with our personal health records that they imagine belong to them,” Peel said. “The only way electronic health records systems will ever work is if the only real stakeholders -- American patients -- control access to our sensitive medical records. We are the only ones who know who we want to see our records, and when and where the records should go.”

AHIMA said it will continue to gather research on HIE progress over the next months with an emphasis on stakeholder input.