Financial sustainability, privacy and security questions aboundThe promise of health information exchanges is not in question, but whether they can be sustained and thrive is. As health care moves to a patient-centered paradigm, HIEs are the conduit through which patient data is provided across the entire care continuum.
Ideally, HIEs improve care while lowering costs by, for instance, minimizing redundant tests, reconciling medications from multiple providers and providing critical information in emergency situations.
"Physicians find our HIE extremely beneficial to clinical decision-making because more data from more places is now available," says Mary Anne Leach, vice president and chief information officer, Denver Children's Hospital. Leach says procedures now don't have to be repeated when patients change providers."It's not often we get unsolicited raves from physicians, but they're raving about HIE," she adds.
Perils lurk, however, in HIE waters.
John Mertz, CIO, South Nassau Communities Hospital, Oceanside, N.Y., says HIEs require a radical change in how providers think about data. Providers must now view patient information as the patients' property, not as an enterprise asset."Only once this ownership view changes will institutions be willing to share data with perceived competitors," Mertz says.
Money may be a motivator. Scott Joslyn, senior vice president and CIO, MemorialCare Health System, Fountain Valley, Calif., points out that health information exchange is a requirement to receive stimulus funds.
Still, keeping HIEs afloat financially remains an issue. Several sustainability models have emerged. In one, HIE members pay an administration fee to participate. Another imposes an assessment paid by health care payers.
Stephan O'Neill, CIO, Hartford (Conn.) Hospital, says they're considering a model in which hospitals provide the majority of the funding, with physicians paying a lesser amount."This will only be practical if HIE costs are reasonable and predictable," he says.
Jim Walker, M.D., chief medical information officer, Geisinger Health System in Danville, Pa., says the most effective models charge a small fee per transaction."The Indiana HIE has funded itself for several years using this model," he says.
HIEs also come with legal concerns.
Under the Health Insurance Portability and Accountability Act, HIEs are business associates."Hospitals are required to ensure that business associates such as an HIE comply with any individual privacy preferences of patients regarding limitations on the use of protected health information to which the hospital and patient have agreed," says Alan Lambert, M.D., a lawyer at Butzel Long Attorneys and Counselors, adding that the agreements must also address issues relating to security breaches.
Additionally, hospitals must ensure that physicians verify medical information obtained through HIEs."Reliance on outdated information from third-party providers obtained through HIEs could still expose a hospital to medical malpractice claims," Lambert says.
This article first appeared in the January 2010 issue of H&HN magazine.