Health Information Exchange: Are We At An Inflection Point?

CALL IN THE FEDS? THE FEDS THEMSELVES AREN’T SO SURE

Russell P. Branzell, a former CIO who this spring became CEO of the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME), has been speaking out publicly, including in May at the Healthcare Informatics Executive Summit in San Francisco, about what he sees as the need for federal government intervention in this area. As Branzell, who calls himself a “small-government kind of guy,” sees it, ONC or CMS needs to intervene, soon, to establish data-exchange standards at a far more granular level in order to address the kinds of concerns described above by Mark Frisse. In late May during a visit to Washington, D.C. to meet with federal legislators and agency officials, Branzell reported that “We had a specific discussion with CMS, and the key to HIE success will be standards, standards, standards,” Branzell says. “We’re still working with a level of standards that is not granular enough to eliminate variability; there is still tons of variability at the EHR level. In my view of the world,” he adds, “this is a rare example of where you want the government to be as prescriptive as they possibly can,” in order to help resolve this EHR-level interoperability problem.

Russ Branzell

But do the feds want to step in? Judy Murphy, R.N., deputy national coordinator for programs and policy, says that everyone should pause to consider what’s being asked. “Russ is coming from the standpoint of ease of implementation,” Murphy says, “and what he’s describing, actually, is constraining the standards, so that we would specify, Use Block A, Use Block B, and Use Block G. Some folks have gathered together to start to do that. For example, there’s a collaborative in New York that is constraining the standards; and then it becomes more plug-and-play, because you’re using a specific standard, and therefore, the implementation is actually easier.” But, she adds quickly, “Basically, I do not believe that there is an appetite in our industry for a lot of specificity in this space. The reason I say that is that there already has been a lot of discussion of this through the Standards & Interoperability Framework, which was launched in January 2011 by the ONC [http://wiki.siframework.org/]. And we have not heard a call for that in that space,” Murphy adds. “In fact, the folks developing standards have wanted to use a building-block approach or the option of being able to pull standards in; and more importantly, using a consensus-based process for building those standards. Unless the appetite of the entire industry changes dramatically in this space, I’m not sure that we’re going to get a lot of support for changing this model.”

Judy Murphy, R.N.

MOVING FORWARD, STEP BY STEP

In the meantime, HIE leaders across the country continue to move forward to build sustainable HIE infrastructures and process. For example, Chris Carmody, president of ClinicalConnect, has been leading a broad regional HIE based in Pittsburgh, one that encompasses nine health systems, three long-term care facilities, one pediatric rehabilitation hospital, and one pediatric physician practice, in western Pennsylvania. In fact, Carmody has a dual role; he continues to serve as vice president of infrastructure at the Pittsburgh-based University of Pittsburgh Medical Center (UPMC), one of the founding member organizations in ClinicalConnect.

Data exchange went live among ClinicalConnect members in June 2012; and in addition to the nine health systems participating, the HIE counts about 8,000 physicians, more than 6,000 of them employed by or affiliated with UPMC; the data exchange at ClinicalConnect already encompasses more than 8 million unique patient records in western Pennsylvania. The biggest challenges? According to Carmody, establishing trust among member organizations that are robust market competitors, and developing a comprehensive HIE on a relatively lean budget. He and his colleagues have been partnering with the Pittsburgh-based dbMotion and the Chicago-based Initiate Systems (now a part of the Armonk, N.Y.-based IBM). Carmody says that “I see a bright future ahead of us, with 10 to 20 more organizations joining us in western Pennsylvania.

On the eastern end of that state, the University of Pennsylvania Health System (Penn Medicine) is participating in the Delaware Valley Health Council, which encompasses 44 hospitals in southeastern Pennsylvania, confirms Michael Restuccia, vice president and CIO of Penn Medicine. At the same time, Restuccia notes, Penn Medicine is using the CareEverywhere data exchange capability built into the core EHR solution from the Verona, Wis.-based Epic Systems Corporation.