HHS walks a tightrope on health information exchange, advisory group says

The Health and Human Services Department is undertaking a balancing act as it crafts a nationwide structure for electronic exchanges of patient medical data, a federal advisory workgroup reported Aug. 14.

HHS needs to find the right combination of strong requirements tied to financial incentives that it can put in place while also leaving enough room for innovation, the workgroup advised.

“Too little structure would do nothing to resolve some of the significant barriers that exist today,” states the report from Health Information Exchange Workgroup. “Too much structure would stifle innovation by locking in what exists today and artificially channeling product development toward specific technologies or architectures."

The workgroup presented its report to HHS’ Health Information Technology Policy Committee, which is advising the department on implementation of the health IT provisions of the economic stimulus law. The law contains $45 billion in incentives for providers who show “meaningful use” of certified digital health record systems and $2 billion for fostering health data exchanges. HHS expects to do rule-making late this year.

The most effective incentives would incorporate a requirement for health information exchange into the “meaningful use” criteria, stated members of the workgroup, which is chaired by Deven McGraw, director of the health privacy project at the Center for Democracy & Technology, and Micky Tripathi, chief executive of the Massachusetts eHealth Collaborative.

The current state of health information exchange is “spotty and piecemeal,” the workgroup reported, and the vast majority of exchanges occur in limited number of participants and settings, such as in labs and pharmacies.

Regional health information exchange is rare and “highly variable,” and electronic reporting for public health is almost nonexistent, the report said.

The workgroup recommended that the ability to engage in health data exchange should be a core requirement to demonstrate “meaningful use” under the stimulus law; as part of this, the doctors and hospitals also must show that their patient data systems are interoperable with other systems, as well as private and secure.

To avoid harming innovation, the core requirements should be technology-neutral and architecture-neutral, the workgroup said. To reduce costs for providers, the federal government should certify the health information exchange components on these core requirements, the workgroup said.

This structure would allow providers a choice of models of exchange while still allowing them to qualify for incentive payments under the “meaningful use” criteria of the stimulus law. The doctors and hospitals could exchange patient data directly, through vendor-specific hubs,  transaction-specific hubs, or national or subnational networks, the workgroup suggested.

The workgroup is recommending the certification of health information exchange components. However, it is not recommending that health information organizations be certified in a separate fashion.

The workgroup made no specific recommendations about HHS' Nationwide Health Information Network, a pilot project to demonstrate health data exchange between federal agencies and private entities. HHS is considering ideas for incorporating NHIN into health IT goals.

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