Is the health information exchange landscape as bleak as it appears?

More than $26 billion has been invested, mostly in incentive payments to hospitals and eligible professionals who meaningfully use electronic health records (EHRs). Just a small percentage of the actors in the healthcare system are electronically sharing data, however, according to a report in the latest issue of Health Affairs.

“While the sharing of information electronically (or health information exchange) plays a critical role in improving the cost, quality, and patient experience of health care, there is very little electronic information sharing among clinicians, hospitals, and other providers, despite considerable investments in health information technology over the past five years,” Janet Marchibroda, director of the Health Innovation Initiative and the executive director of the CEO Council on Health and Innovation at the Bipartisan Policy Center (BPC), wrote in the report.

Progress has been made in adopting EHR systems within individual healthcare sectors since the HITECH Act in 2009, the report showed. Indeed, the percentage of physicians adopting at least a basic EHR increased from 21.8 percent in 2009 to 48.1 percent in 2013, according to the National Center for Health Statistics. And 44 percent of hospitals have adopted at least a basic EHR, compared to 12.2 percent in 2009, a survey of hospitals published in Health Affairs indicated.

Nonetheless, the level of electronic information sharing across such systems has failed to make solid gains, the report said. The roadblocks slowing information sharing arise from the nature of the healthcare market, in which patient information resides where care and services are delivered, such as the offices of primary care physicians and specialists, hospitals, laboratories, pharmacies, health plans, as well as with the patients.

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Individual healthcare sectors showed little inclination to share information to other stakeholders.

Just 14 percent of doctors surveyed in 2013 were electronically sharing data with providers outside of their organizations, according to a different recent study. And a 2012 Health Affairs study showed that 51 percent of hospitals surveyed shared information with ambulatory care providers outside of their organizations, while 36 percent shared information with other hospitals. Another report, meanwhile, indicated that only 10 percent of ambulatory practices and 30 percent of hospitals were found to be participating in operational health information exchange efforts.

Marchibroda wrote that the failure to develop healthcare information exchanges was due to “the lack of a business case for information sharing, the cost associated with exchange, and the lack of standards adoption and interoperability of systems.”

The business model driving much of the healthcare system needs to be altered to create an environment in which information exchanges can flourish, the report said.

“Because most payment in the US health care system today is volume-based versus outcomes or value-based, there is little financial incentive to share information across settings to reduce costs or improve the quality of care,” Marchibroda wrote. “The significant increase in adoption of new models of delivery and payment across the United States as well as penalties for hospital readmissions implemented by CMS are expected to expand the business case for interoperability and information sharing. However, so far these new models of care have relied upon old models of information sharing, including the use of phone, fax, or mail, or siloed information-sharing networks.”

Also slowing adoption are infrastructure costs associated with exchange, a dearth of standards and systems interoperability, privacy and security, as well as liability concerns.

Several groups have come forward offering information technology-focused solutions to facilitate adoption.

A group of scientific advisers affiliated with the Agency for Healthcare Research and Quality, in April 2014 put forth a set of recommendations for software architecture for a health data infrastructure and formulated requirements for EHR software vendors to develop, publish, and certify application programming interfaces to facilitate exchange. And in late May, the President's Council of Advisors on Science and Technology (PCAST) issued a report on systems engineering in health care recommending the creation of a health information infrastructure and the development of "universal exchange language" that enables data to be shared.

To develop more ideas to overcome these challenges, the U.S. Department of Health and Human Services sought out ways in 2013 issued a Request for Information on Advancing Interoperability and Health Information Exchange.

Suggested policy and programs included:

• Offering federal contributions toward Medicaid at the 90/10 matching level to support health information exchange activities;
• Adding requirements within CMS's conditions of participation or coverage for a wide range of health care organizations; and
• Including requirements for accountable care organizations under the Medicare Shared Savings Program and those participating in the Center for Medicare and Medicaid Innovation pilot programs, including those associated with bundled payments, primary care, and other accountable care arrangements.

The development of information exchanges is now essential for the overall modernization of healthcare in the U.S.

“The US health care system is undergoing significant change in response to concerns about rising healthcare costs and uneven quality,” Marchibroda wrote. “Innovative strategies associated with care delivery, payment, and engagement of individuals are rapidly emerging to address these challenges, but such strategies must rely on information sharing across the healthcare system to be successful.”

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