What's holding back HIT? Institution-centric systems

A lack of progress on health information exchange is preventing the United States from fully realizing the benefits of health information technology (HIT), leaving HIT's promise "largely unfulfilled," according to an editorial published in JAMA.

Attempts at health information exchange have thus far been "discouraging" and have been plagued by privacy concerns, lack of stakeholder cooperation, and minimal financial stability, according to authors William Yasnoff, MD, of Johns Hopkins University; Latanya Sweeney, PhD, of Harvard University; and Edward Shortliffe, MD, of Columbia University.

Health information exchange is important because it represents health providers' means of sharing patients' electronic health records (EHRs), ideally allowing for patient data to be accessed, integrated, and understood by providers.

The problem with health information exchange as it stands today is that little progress has been made on the "exchange" part. For example, the authors cite a statistic from the federal government that in 32 states more than 90% of hospitals have yet to electronically exchange even a single patient record.

Most EHR systems as currently organized are centered on a single hospital or clinic, an approach that fails to deliver what would create the most value to the health system: a single unified record for each patient.

"Institution-centric systems are being built, often leaving patient information where created and then retrieving and integrating it in real-time only when needed," the authors write."This approach is seriously flawed."

The consequence of this health information exchange failure is that HIT hasn't fulfilled its promise of improving the quality of care while reducing cost. In fact, HIT actually is increasing costs as EHRs allow for improved documentation, or upcoding, which increases reimbursement to physicians.

So what's to be done about creating a single, lifetime patient record? The authors propose a solution that they say is simple, scalable, secure, and less expensive than other alternatives: "patient-centric community health record banks."

Health record banks are community organizations that put patients in charge of a comprehensive copy of all their health information, including medical records and other data of their choosing. Patients may control who is able to access their health information, allowing providers access when care is sought. When care is complete, the new record from the visit is deposited into the record bank and made available for the future, the authors say.

This approach would solve the problems of privacy, stakeholder cooperation, and financial stability and also could coexist with hospitals and provider groups keeping their own copies of records, they write.

The authors draw a distinction between this more localized approach to patient-centric records versus the nationwide focus of failed personal health records projects by Google and Microsoft. In the latter, patients had to manually authorize each link from their records to a medical information source. In contrast, the community-centric approach of health record banks would allow for electronic connections to medical information sources to be created automatically, according to the authors.

"It is time for physicians to insist that HIT be pursued with realistic, achievable, and measurable goals that will produce readily available, comprehensive electronic records that can actually improve patient care," the authors conclude.

Be sure to read the cover story on meaningful use 2 and interoperability in the March 25, 2013, issue of Medical Economics when it becomes available.

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