Following ONC's release of its Program Information Notice "Privacy and Security Framework Requirements and Guidance for State Health Information Exchange Cooperative Agreement Program," (the P&S PIN discussed in a previous blog post) the National eHealth Collaborative (NeHC) has released a roadmap for successful and widespread growth of HIE to improve health and healthcare after extensive collaboration with private and public stakeholders (the HIE Roadmap). NeHC is a pubic-private partnership established through a grant from the ONC and is led by some of the nation's most respected thought leaders, and so we were thrilled to discover that our blog, Legal Health Information Exchange, was identified by NeHC as one of only a selected group of "Helpful Resources" found at Exhibit B of its HIE Roadmap. You can register with NeHC to download a copy of the HIE Roadmap here.
Entitled "The Landscape and a Path Forward," the HIE Roadmap sets forth current HIE connectivity and exchange approaches across the nation, as well as federal efforts towards developing the foundation for interoperability and trusted HIE through common standards, services and policies. It highlights those strategies for integrating these federal and private sector efforts, emphasizing the current progress that has been made and those challenges and barriers remaining to be overcome.
Most importantly, it hopes to provide a roadmap of the major steps communities can follow to achieve progress towards HIE. The HIE Roadmap states,
...Given the rapid market and policy changes and technology innovations occurring right now, there is confusion among healthcare stakeholders about how best to proceed with implementing HIE. Leading HIE organizations are indeed charting new ground. Emerging HIE efforts can and should learn from those who are further along in order to...leapfrog toward success."
It notes that in 2010, the number of public HIEs increased 81% from 37 to 67 with a whopping 210% increase in operating private HIEs, from 52 to 160. Providing clear examples of leading HIE efforts, their leverage of national standards for exchange, and other factors contributing success, the HIE Roadmap seeks to capture the vision for why HIE is important to improving patient care and to the performance of our healthcare system, as well as provide a framework and a path forward for those working towards achieving HIE in their communities.
The HIE Roadmap highlights several of the most notable challenges and barriers to HIE, including:
- Funding and sustainability;
- Variations in implementation of interoperability standards;
- Provider adoption;
- Disparate EMRs; and
- Privacy and security concerns.
However, it recognizes that these challenges and barriers are being "tackled and overcome." The HIE Roadmap highlights ONC efforts towards building a foundation of interoperability and trusted exchange, in particular, recommendations of the HIT Policy and Standards Committees and their workgroups, such as the Meaningful Use, Information Exchange, and Privacy and Security Policy Workgroups. It highlights the importance the Direct Project and the Nationwide Health Information Network (NHIN) continues to play in developing a strong interoperable foundation and the potential the Direct Project and NHIN have to promote best practices, compliance with existing national standards and implementation recommendations, and following through responsibility to protect health information.
The HIE Roadmap describes the approaches taken by several HIE initiatives across the nation, including:
- Care Connectivity Consortium, comprised of five leading health systems, Kaiser Permanent, Mayo Clinic, Geisinger Health, Intermountain Healthcare and Group Health;
- HealthBridge, with 50 participating hospitals, 800 physician practices, and 7,500 physicians;
- Indiana HIE (IHIE), with 90 hospitals and 19,000 participating physicians;
- Inland Northwest Health Services (INHS), with an air ambulance collaborative, rehabilitation hospital, and IT management for 38 hospitals and EMR services for 750 physicians, and which also partners with the Departments of Defense and Veterans Affairs; and
- Kaiser Permanente, which includes the Kaiser Foundation Health Plan and subsidiaries, 37 hospitals and over 450 clinical facilities, and the Permanente Medical Group Practices.
While highlighting the various strategies implemented by these initiative, the HIE Roadmap also recognizes that,
Indeed, interoperable HIE is a journey without a definite endpoint. Many different approaches are being used, stakeholders are at different stages along this journey, and there is by no means a "one size fits all" model.
It notes, however, that a key priority of many of these initiatives is to provide standards-based services to small physician practices, recognizing that most healthcare is delivered in these physician practices and the challenges they face. Finally, the HIE Roadmap sets forth four major "steps" or phases for implementing successful and sustainable HIE, which starts wtih developing the HIE's objectives and vision.
In conclusion, the HIE Roadmap states,
The ultimate goal of HIE is to ensure that the right information is available at the right time and place every time to support the delivery of high quality, well coordinated, and cost effective patient-centered healthcare. Keeping a consistent and clear focus on what is best for the patient is above all else the smartest way to stay on course in the ever-changing environment of HIE.