Farzad Mostashari, M.D., may have understated things yesterday during an ONC-CMS webcast on health information exchange: "This is complicated but we are making progress. It took a decade for ATMs to be interoperable, and they only use seven data fields."

The outgoing head of ONC is a zealot for health information exchange. "We cannot have it be profitable to hoard patient information and unprofitable to share patient information" he added.

The unfortunate reality is that health information exchange is lagging. Our own Most Wired data show that 51 percent of Most Wired hospitals and 43 percent of all respondents make clinical documentation available electronically to independent physician practices, compared with just 43 percent of all respondents. Just 40 percent of Most Wired hospitals and 24 percent of all respondents make a patient’s medication lists and history available electronically to nonaffiliated hospitals.

Other studies, including one based on an AHA survey that appeared in the newest Health Affairs, also show there’s significant room for improvement. The issue may be coming to a head on the policy front. ONC and CMS yesterday laid out a vision for accelerating health information exchange. In a report released simultaneous to the webcast, the agencies suggest that new payment models could be used as vehicles for mandating more information exchange. The report, "Principles and Strategy for Accelerating Health Information Exchange," was in response to a request for information the agencies issued earlier in the year.

Hospital officials, though, caution policymakers not to move too rapidly on additional mandates. Meaningful use stage 2 rules require a fair amount of information exchange, they point out. Additionally, new delivery and payment models currently being tested necessitate better information exchange across the continuum.

"The AHA supports these new payment and delivery models, and hospitals around the country are engaged in their implementation," said Chantal Worzala, director of policy at the AHA. "We do not believe it is productive, however, to add specific information exchange requirements to these projects, as the mechanisms of exchange may vary by project, and the specification of requirements could result in unintended consequences, including limiting innovation and posing a reporting burden. … This seems like an opportune time for evaluation, learning and sharing of best practice. We really need to learn what works before adding new requirements."

One critical area that ONC-CMS said will get extra attention is standards. Not only did the agencies pledge to "advance multi-stakeholder" standards development, but they also plan to "accelerate interoperability through adoption of HIT standards through a variety of policies and programs."

Overall, the infrastructure to support information exchange must be addressed, Worzala said. "We need provider directories, efficient and mature exchange networks, and support for providers to learn how to use national standards to share data. That includes a single, national approach to matching patients to their records. Once all providers have access to networks that allow them to efficiently share data electronically, as a streamlined part of the care process, other incentives will lead them to share data to support clinical care."