ONC outlines next steps in HIE strategy

The Office of the National Coordinator for Health IT expects to see substantial progress this year on the fundamental components that will promote health information exchange, such as provider directories, certificates to ensure identification and “rules of the road” for the Nationwide Health Information (NwHIN) Exchange.

Health information exchange (HIE) will build upon a variety of models to be able to scale up information sharing among physicians, hospitals and patients -- and across care settings as called for in the meaningful use stage 2 proposed rule. Over the years, ONC has considered a national architecture of regional health information organizations and most recently a large role for single statewide HIEs.

Farzad Mostashari, MD, the national health IT coordinator, said health information exchange will not become a reality as a single vision or system but instead will include many models and business plans.

“It’s going to be a little messy but very liquid and fluid, where there will be lots of different means for information to go where it needs to go. The vision we have is around standards, around directories, and a whole host of different ways that information can be shared and understood,” he said at the March 7 meeting of the advisory Health IT Policy Committee.

Although private information exchanges have grown and health IT vendors are enabling large networks, such as Surescripts’ e-prescribing network, sharing health data among providers for care coordination is not happening yet, said Claudia Williams, director of ONC’s state HIE program.

Surveys have shown that about 73 percent of the time primary care providers don’t get discharge information within two days. And only about 20 percent of hospitals have a mechanism in place to share clinical information electronically with other providers outside their system.

“We can’t wait. We have to have actual change occurring in stage 2,” Williams said.

“When you look at [requirements] to support care transitions, we need a way that is ubiquitous so that when you refer someone, discharge or send a lab result, that information goes to the next point of care,” she said, adding that is a goal for this year. Williams published an article in Health Affairs' March issue that outlines ONC's HIE architecture strategy.

ONC’s role is to put those building blocks in place to reduce providers’ burden and cost by identifying standards, finding ways to support positive market developments, and jump-starting needed services for an HIE program so that, for example, the need for $10,000 lab interfaces can be minimized, Williams said.

Stage 1 laid the foundation with standard vocabularies, code sets and content structure so that EHR data could be understood by and incorporated into another provider’s EHR.

ONC is focusing on the next set of building blocks to accelerate health information exchange, including:

  • directories to look up providers or maintain a list of providers in a way that others can find the information, including figuring the data elements needed to query or to open up a directory;
  • digital certificate management and discovery to support Direct connections to establish identify and authentication and to make the public keys findable; and
  • governance or a common set of rules of the road to build trusted exchange and to make the NwHIN Exchange more scalable.

The state HIE program may evolve from building a single network in a state to starting up needed services to support providers to exchange, Williams said. For example, in California, there are 19 exchange networks, some well-established and some not.

“The challenge is to attract investment so they can all move forward together in a way that protects patient privacy and allows for exchange -- and so that exchange can occur across networks,” she said.

Later this month, five states will start consumer data-sharing efforts for the next six months around immunization records, sharing their HIE data, and figuring a way to take repository information and do a patient match into a PHR, Williams said.

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