Earlier this year, ONC and CMS issued new draft guidelines requiring that all insurers and providers serving the Medicare population make their data available electronically by 2020.
The new rules will establish penalties and fines for providers and health plans that don’t make health records available via a standard API by 2020 and as well as penalties for providers who create obstacles to data sharing. They would also require hospitals and emergency departments to notify patients’ primary care providers about admissions, transfers or discharges and use HL7 FHIT and the US Core Data for Interoperability.
According to some critics, however, the guidelines don’t go far enough. In a new article appearing in the Health Affairs blog, for example, authors Michael Hochman, Judith Garber and Edmondo Robinson argue that it’s time to switch to a “more assertive” approach to data sharing.
However, the authors contend that these guidelines won’t be sufficient to jump-start further data sharing. Among other issues, they say, there are too many opportunities for regional HIEs to butt heads and engage in turf wars. Also, they note that while effective HIEs need specialized tools and processes for exchanging data, only a small number of regional HIEs have such tools in place.
To move past this and other challenges standing in the way of HIE advances, it’s time for the federal government to get more directly involved in the development of U.S. HIE infrastructure, the authors suggest.
In particular, they favor the development of a public HIE which would be available to all US providers. If they had this option, local communities would not have to take on the building of their own HIEs, and existing regional HIEs could hook themselves up to the public network. The national HIE could also offer access to best-of-breed tools allowing patients to request their records.
The authors admit that it would be necessary to address some significant issues before plunging ahead with such a plan, such as how the national HIE would be funded, who would govern it and how privacy protections would be handled. Patient matching could also prove to be a significant challenge given how many patients in a national database would have the same names and dates of birth.
Even given these challenges, there are several reasons why a national HIE effort might succeed despite the failure of previous state efforts, the authors wrote. For example, with a national HIE in place, it would be clear who was in charge, which would give its leaders enough authority to succeed, they say.
Also, a national network could choose from a number of effective tools available now and make them available nationally. (The authors cite the CommonWell Health Alliance platform as an example.)
It’s worth bearing in mind that this is all speculation. We don’t yet know if a national, more-centralized model would close gaps or collapse of its own weight, save money or impose massive additional costs. But given how patchy and uncoordinated existing HIE efforts are, it’s worth reconsidering our current HIE assumptions.