“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.”

[See also: CommonWell names 3 biggest HIE hurdles.]

Infrastructure a hurdle
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 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 when it 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.”