The study is the first of its kind to report trends in health information exchange, the subject of several high-profile bills currently circulating in Congress and a key issue for the Bush administration. eHI's survey of health information exchange collaborators takes the pulse of progress of the more than 100 multi-stakeholder efforts across the country, representing initiatives in 45 states and the District of Columbia. The study shows that these state, regional or community efforts are rapidly advancing through the steps necessary to electronically exchange health information in an effort to improve health care quality and safety and health care savings while preserving the security of individual health care information.
The survey was conducted by the eHealth Initiative Foundation with support under a co-operative agreement with the Health Resources and Services Administration Office of the Advancement of Telehealth of the Department of Health and Human Services.
"These findings are key to help inform public policy initiatives to support interoperability and the use of information technology to address health care challenges", stated John Glaser, Ph.D., vice president and chief information officer of Partners HealthCare and president of the board of the eHealth Initiative (eHI). John Glaser addressed the financial barriers to the adoption of health care IT in July testimony before the Senate Subcommittee on Technology, Innovation and Competitiveness of the Senate Committee on Commerce, Science and Transportation.
"The results of this survey will also help health care stakeholders including clinicians, health plans, state and local government agencies, health care purchasers, hospitals and other providers, gain a greater understanding of the challenges these initiatives face", John Glaser stated. "It is clear that HIE initiatives are moving from discussing to operating but there is still work to be done."
The survey analysed data from 109 responses from health information exchange efforts across the country. Respondents were asked to identify their stage of development within a range of six clearly defined stages. Forty-four respondents said they were still within the early stages of development (between stages 1 and 3). Sixty-five identified themselves as being in the advanced stage of development (between stages 4 and 6). Among those in the latter stages, 25 HIE efforts described themselves in the "fully operational" stages, a significant uptick from a 2004 eHI assessment of only nine operational HIE efforts nationwide.
"We saw a dramatic increase in the level of interest in and activity related to HIE in regions across the country", stated Janet Marchibroda, chief executive officer of eHI. "A number of new HIE efforts have emerged over the last year and survey results show that these efforts have matured considerably with respect to engagement of key stakeholders, organisation and governance, functions and services offered, and the development and execution of technical infrastructure to support their efforts."
While HIE initiatives are maturing, the survey shows that there is still work to be done. "These initiatives still need to overcome financing and sustainability issues, develop a deeper understanding of the technical and organisational issues and aggressively share what they have learned in order to succeed, and to help other communities to succeed", stated J. Marc Overhage, MD, Ph.D., chief executive officer, Indiana Health Information Exchange, who co-chairs eHI's Working Group for Connecting Communities.
J. Marc Overhage said the study's findings will help health information exchange initiatives take a bearing on their levels of readiness and progress and create a clearer picture of the work from other regions and communities conducting similar initiatives. "It creates the impetus and opportunity for networking and accelerated learning", he stated.
Use of information technology to enhance patient care, safety, and create a more efficient health care delivery system has garnered remarkable bi-partisan support in recent weeks. Over the last two months, five Congressional bills related to improved health care for patients through new quality, incentive and HIT practices were introduced, including the Senate Health Education, Labour and Pensions (HELP) Committee's Wired for Health Care Quality bill (S. 1418), the Senate Finance Committee's Medicare Value Purchasing Act (S. 1356), the Frist-Clinton bill on health technology and quality (S. 1262) and the Health Information Technology Act authored by Sens. Debbie Stabenow (D-MI) and Olympia Snowe (R-ME). The House Ways and Means Committee Republican leadership also introduced its own Medicare Value Purchasing for Physician Services Act on July 29. Five other bills have been introduced this year in Congress to encourage provider adoption of information technology and development of a national health information network.
"Together, these latest bills recognize the importance of the need for funding to support providers, states, and regional or local health information networks as they begin to invest in health information technology to support improvements in health care", Janet Marchibroda stated. "Our survey showed that upfront funding and finding a sustainable business model were key challenges for the vast majority of HIE efforts."
Mark Frisse, MD, heads the development of a state-wide infrastructure to support Tennessee Medicaid patients and a regional demonstration project in the Memphis area. He also serves as co-chair with J. Marc Overhage for eHI's Working Group for Connecting Communities, and is director of regional health initiatives at the Vanderbilt Center for Better Health.
"The survey results demonstrate that these initiatives are in different states of readiness with regard to organisation and governance, legal issues, financing and sustainability and technical aspects", Mark Frisse stated. "The survey results are valuable to those of us on the ground as we work through issues and track our progress. Community to community we share a commitment to work with other markets to advance knowledge of application and use of HIT in the development of a more efficient and responsive health care system, tracking our progress is important."
Like patients and consumers, leadership of health information exchange efforts are also concerned about security. Of advanced organisations already exchanging information electronically, 59 percent go beyond HIPAA requirements in their policies for data exchange. Eighty-three percent of advanced stage respondents reported having contractual agreements among health information exchange participants, 92 percent of which cover authorization of users, 89 percent of which cover privacy and security procedures, and 87 percent of which cover terms for information use.
The eHI Foundation survey results will be made available to eHI members, the general public and several public and private sector bodies, including the Agency for Healthcare Research and Quality National Resource Center for Health Information Technology. The latter is supporting leaders using health information technology to promote patient safety and quality through over 100 grants and contracts.
Since 2003, the eHealth Initiative Foundation has been working with leaders at the state, regional and community levels to build multi-stakeholder collaborations focused on mobilizing health care information across organisations to improve the quality, safety and efficiency of care. The eHealth Initiative and its Foundation are independent, non-profit affiliated organisations whose missions are the same: to drive improvement in the quality, safety and efficiency of health care through information and information technology.
Key findings from the report include:
- Health information exchange activity is on the rise.
- The key driver moving states, regions and communities toward health information exchange is perceived provider inefficiencies with rising health care costs also seen as an important driver.
- Health information exchange efforts recognize the importance of privacy and security.
- Health information exchange efforts are maturing: organisation and governance structures are shifting towards multi-stakeholder models with the involvement of providers, purchasers and payers.
- Advancements in functionality to support improvements in quality and safety are evident.
- HIE efforts are delivering more information and increasingly using standards for data delivery.
- Securing funding to support start-up costs and ongoing operations is still recognized as the greatest challenge for all HIE efforts. Engaging health plans and accurately linking patient data also seen as a challenge.
- Funding sources for both upfront and ongoing operational costs still rely heavily upon government funds but alternative sources for ongoing sustainability are beginning to emerge.