On Monday, April 2, the National eHealth Collaborative (NeHC) released its “Health Information Exchange Roadmap: The Landscape and a Path Forward,” a four-phase blueprint toward sustainability to help accelerate health information exchange (HIE) initiatives. On the report’s release, NeHC sponsored a webinar briefing featuring NeHC CEO Kate Berry, representatives from Office of the National Coordinator for Health IT (ONC), the U.S. Department of Veterans Affairs, and HIE pioneers.

One of the major topics tackled by the report, which was reviewed by 70 different industry leaders before publication, was ONC-led efforts to develop nationally recognized standards that can be leveraged by local HIE initiatives and how those standards work in harmony with local efforts to create interoperability. Chris Muir, senior program analyst and state HIE project manager, ONC, said his department was focusing on three areas, which include improving Direct standards for basic exchange, and continuing to work on query-based and consumer-mediated exchange.

Muir admitted that the industry has been challenged by the sheer expense and many resources HIE development requires. “Right now there’s just not enough money to go around to meet everyone’s needs and desires of having that robust exchange,” he said. “And another complicating factor is there is a diverse number of models out there to accomplish exchange, not only technology models, but also business and policy approaches.”

Another area of the report delves into examples of where national standards are currently being leveraged by diverse initiatives to provide innovative HIE functionality and services. For example, providers in Rhode Island use Direct standards to transmit CCDs to their statewide HIE, currentcare. “Once we have a good number of CCDs from a practice that come from a majority of their patients, we’re able to do analytics on their patients,” said Laura Adams, president and CEO, Rhode Island Quality Institute, which is the state’s REC and runs the HIE. “We use Direct to first get that information out of the EHR and up into the HIE where there’s sophisticated analytics. Then we can send that information back to the providers via Direct.”

The VA has been taking different approaches to providing better care to veterans through information exchange, including query-based exchange, Blue Button, and Direct, said Tim Cromwell, R.N., Ph.D., director of standards and interoperability for the Office of Informatics and Analytics at the VA. Cromwell noted that seven out of every 10 veterans receives healthcare from the private sector, so the VA has been using Direct to send and receive patient information when a patient has to go outside the VA to get a service, like a mammography. “We will complete a round-trip where we push out the authorization for care using the Direct project; then we’ll expect pushing back to us the report from that care,” Cromwell said.

While Inland Northwest Health Services (INHS), which is also a Beacon Community based in Spokane, Wash., does not have any Direct projects underway, it has learned a lot in the past year that it has been operating, said CEO Tom Fritz. The exchange has more than 130,000 patient records, but as Fritz admitted, it has taken the exchange substantially longer to map all the data to take action from a population health perspective. “Clearly, one of the major challenges has been the whole issue of integrating outpatient clinical data from primary care physicians’ offices,” he said. “So, even though they have a multitude of EMRs, they all have been implemented and customized in a thousand different ways, with no standardization of datasets or data definitions.”


Tom Fritz

Beyond providing the major steps communities can follow to accelerate successful deployment of interoperable EHRs and real-time information sharing through HIE, NeHC will soon be convening collaborative workgroups on important topics to identify and share best practices to accelerate HIE progress. Rhode Island Quality Institute’s Adams emphasized the importance of passing along this institutional knowledge. “People who’ve been at this for a while don’t realize how much history, background, context, and learning we take for granted,” she said. “This all has to be reported and served up to newer entrants. And these workgroups are opportunities for newer entrants to challenge our current thinking.”

“This report and the ensuing workgroups are important because we’re all benefitted every time an HIE succeeds,” said Adams, “and we’re certainly all affected every time one of them fails.”