As part of the morning program Sunday at the CHIME CIO Forum, three healthcare IT leaders discussed a wide range of issues currently facing health information exchange (HIE) development industry-wide, in front of an assembled audience of about 520 healthcare IT executives gathered together at the Orange County Convention Center in Orlando, by the Ann Arbor, Mich.-based College of Health Information Management Executives (CHIME). Gretchen Tegethoff, CIO of The George Washington University Hospital in Washington, D.C., led a panel discussion with Indranil (Neal) Ganguly, vice president and CIO, CentraState Health System, Freehold, N.J., and John Mattison, M.D., chief medical information officer at the Oakland, Calif.-based Kaiser Permanente system.
Among the issues that were discussed in some depth were HIE sustainability, the technical and other barriers to entry into the market, data privacy and security, the concept of a voluntary unique patient identifier, and the NHIN-direct-versus-NHIN-exchange debate. Mattison, who noted that when he arrived at the Kaiser organization several years ago, faced the prospect of creating interoperability among more than 2,000 information systems in order to achieve HIE within Kaiser alone, said that one very fundamental issue is that of trust, at all levels—between hospitals and physicians, at the community data exchange level, and at the regional and national levels.
“I think it’s really easy to overestimate the technical issues around HIE, because they are many. But the real issue is trust, between provider and patient,” and all the way through the healthcare system, he emphasized. But, he added, “the biggest problem that we’re facing on the NHIN Coordinating Committee is that we have a very long on-boarding process, and a very long line of Beacon communities and other organizations in line. So we’re trying to make the on-boarding process easier. The other issue,” he said, “is the critical mass. The tipping point of how often a physician actually exchanges information is rather critical. And in the next year or so, more and more communities will pass the tipping point in terms of [volume of] exchange, and really reaping the benefits of care.”
In terms of patient data security and privacy, Mattison spoke at length about some of the complexities and intricacies involved. “There are 10,000 Maria Gonzalezes in the Los Angeles basin area alone,” he noted. He said he believed that one important element will be convincing patients to join a voluntary unique patient identifier program that can ultimately scaled up to a national level, in order to achieve patient and consumer confidence in the HIE phenomenon.
Another issue that came up was the medical semantic interoperability issue. “One of the things that we need to identify is that we’re not going to be able to achieve a common political framework across all states,” Mattison said. “Instead, we should focus on achieving a common framework and taxonomy; that’s a first step that hasn’t even been addressed initially.”
“Absolutely,” Ganguly agreed. “And we understand that there are political challenges and that ONC [Office of the National Coordinator for Health Information Technology] can’t necessarily impose guidelines across the whole country.” In addition, Ganguly said, “sustainability is a key concern as well. And to the degree that we are setting up these regional HIEs now without any significant government support, it does amount to a tax on providers; and maybe that’s necessary and OK, but we’ve got to be careful about how we handle that element,” in order to not make physicians feel that their money is being wasted.
In response to an audience member’s question on engaging patients in order to promote health information exchange, Ganguly agreed that it is becoming increasingly important to begin that work. “Part of what we need to do at the HIE level is to take on that kind of ‘PSA’ role,” he said, “for example explaining why it’s important to have a unique patient identifier, so that when you come to the hospital as Maria Gonzalez, you’re not confused with that other Maria Gonzalez.”