Electronic health information exchange is coming-but slowly

One of the goals of the federal electronic health records (EHR) incentive program-also known as Meaningful Use (MU)-has been to make it possible to quickly and easily exchange clinical information in electronic form between providers in separate locations using different EHR systems.

Stage 1 of MU was focused mainly on getting physicians off of paper charts and onto an EHR, whereas Stage 2, which starts in 2014, puts more emphasis on information sharing between care settings. In fact, health information exchange is among the requirements doctors must meet to qualify for MU2 financial incentives.

EHR vendors challenged

Information exchange, or interoperability, poses a significant challenge for EHR vendors, because until now EHRs have not been designed to communicate with one another-and in fact have little financial incentive to do so.

Fortunately, other solutions to the interoperability problem are starting to materialize. Among these is the development of a standardized structure for the continuity of care documents (CCDs) and continuity of care records (CCRs) generated by EHRs, as well as secure protocols for transmitting them between providers,  because EHRs must be able to export and receive data from these files to receive MU2 certification.

Exchange networks growing

Even more important is the growth of health information exchange networks that provide a set of common standards to their members for sending and receiving data electronically.  These are being created by private hospitals and integrated health systems, as well as by states and other public entities. The federal Office of the National Coordinator for Health Information Technology has provided funding for 56 public entities.

In addition, six major EHR vendors recently announced plans to form their own consortium, the CommonWell Health Alliance, with the goal of promoting and certifying a national infrastructure with common standards and policies for health information exchange.

The Direct Project

The Direct Project, a consortium of EHR vendors, medical organizations, government agencies, and consultants, is yet another emerging method for transmitting messages securely and in standardized formats between different EHR systems. Direct Project protocols are expected to be part of MU2-certified EHR systems beginning in 2014.

Independent practitioners may find accessing interoperability technologies more challenging, at least at first. Regional extension centers,  state and local medical societies, and local hospitals are potential sources for  information about health information exchanges.  The exchange itself will provide information about service agreements, costs, and privacy and interoperability standards.

Our healthcare system and technology infrastructure has a long way to go before we can send patient data quickly, reliably, and securely between providers in different locations who use different EHR systems. The good news is that we have made considerable progress towards reaching that goal recently, and I feel confident that we will attain it in the next few years.

The author is a healthcare information technology consultant in Hayward, California, and author of the blog RobertRowleyMD.com. Send your health information technology questions to medec@advanstar.com.