Health Information Exchanges Lack Standards

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Health information exchange (HIE) adoption rates are on the rise, but plenty of challenges remain in exchanging data efficiently, according to a recent Healthcare Information and Management Systems Society (HIMSS) report.

The influential research non-profit surveyed 157 senior hospital IT executives, and found more than 70% of respondents participated in HIEs with other hospitals and health systems.

"Based on high participation numbers, hospitals clearly understand the value of electronic sharing of health-related information among organizations," said Jennifer Horowitz, senior director of research for HIMSS. "But meaningful engagement between healthcare organizations and easy ways to share patient information…still remain a challenge."

The biggest challenge facing HIEs' success is data normalization and standardization, said John Hoyt, an executive VP at HIMSS.

[ The stakes could get higher for data exchange. Read Will Health Information Exchange Become Medicare Payment Criterion? ]

Multiple nomenclatures are used to describe the same diagnoses, patient identifications, lab results and medications. At this point, the inconsistencies are processed by humans, a costly and timely endeavor. Forty-two percent of respondents characterized their output/print environment as "high effort." People are paid to accept data element by data element and input those records into a computer system. There are committees working to standardize the nomenclature, but success in that realm is down the road, Hoyt said.

Until the data is normalized, the true potential of HIEs will be stunted. That potential lies in the ability to instantaneously act on the exchanged information. Ideally, two doctors sharing the same patient will be able to automatically absorb each other's separate patient data.

The automatic component is where HIEs falter. Sixty-four percent of the health information organizations (HIOs) surveyed reported that sharing data with hospitals not participating in an HIO was conducted via fax, with 63% of those same HIOs processing faxed information via scanning.

"A PDF is not as intelligent as you want it to be," Hoyt said. "You want the patient's record to be refreshed every time you open it. We're making progress, but we have yet to see a tipping point in that regard."

The "action" component comes when processing the information in front of the doctor. When reading a PDF, it's the doctor's responsibility to learn the new information added to the record. If the system were computerized and automated, it would file an alert every time new information was added.

Previous InformationWeek coverage of HIEs included the hypothesis that competing organizations are reluctant to share information with each other because in a fee-for-service model, fewer tests and labs means decreased revenue.

"The federal government needs to change the incentives," Hoyt said. "There are structures in the Affordable Care Act for hospitals to accept at-risk payments where they're responsible for a population. Therefore, they're motivated to learn as much about the patient's health and consumption as possible."

Hoyt said the industry won't be seeing much immediate progress on improving the success of HIEs, especially with the lack of a clear business model.

"There's certainly federal interest, although insufficient funding," he said. "The future looks long-term, but bright. If we don't find a viable business model, it's not going to work. The day should come where if you go to Paris, you can access your medical record from Detroit."