For most of her tenure as National Coordinator for Health IT, Karen DeSalvo, M.D., has spoken in general and broad terms when talking about the goals of the Office of the National Coordinator for Health IT (ONC). It’s to be expected from a federal official—it’s what they do to avoid any slip-ups that could lead to backlash. As a journalist who covers health IT, that could get bland. So on Tuesday at a Bipartisan Policy Center event in Washington, D.C., when Dr. DeSalvo said that one of her agency’s main priorities for 2016 is to connect all private and public health information exchanges (HIEs), naturally, my ears perked.
Here’s the specific quote from the Dec. 8 event which I watched the webcast of: “We have built—through the hard work of the private sector and states—an infrastructure where every state has an information highway. In some communities, it’s already connected across state lines. Our goal is to connect that highway, including the health information exchanges [and] the private sector exchanges, in the entire country within a year,” DeSalvo said. The aim, she said, is that information will be available to a patient’s provider wherever he or she might be in real time so that he or she can address the patient’s clinical needs.
After reading that quote, I could only imagine what providers are thinking: “Yeah, okay!”
The ONC itself even wasn’t this ambitious when in October, it released the final version of its Interoperability Roadmap, laying out the steps needed to achieve an interoperable health IT infrastructure in 10 years. The report outlines a timeline of actions, in three-, six-, and 10-year milestones, to guide stakeholder focus in the near- and long-term toward the goal of achieving an interoperable healthcare system. Specifically, from 2015-2017, ONC said the aim is to send, receive, find and use priority data domains to improve healthcare quality and outcomes; from 2018-2020, the goal is expand data sources and users in the interoperable health IT ecosystem; and from 2021-2024, the goal is a learning health system with the patient at the center.
To be fair, ONC has said that the Roadmap is a living document that is subject to updates as milestones are met and new challenges emerge. That being said, connecting HIEs, both public, and private, within a year, seems incredibly unrealistic and not in line with what the feds have previously outlined. Taking ONC’s words out of it for a second, just the HIE challenges alone that we constantly hear about would make this objective awfully tough to accomplish.
As I noted in my story yesterday, various health IT experts have expressed, in interviews with Healthcare Informatics over the past number of months, the many challenges they are seeing and hearing in regards to HIEs. Research has backed these sentiments up as well. According to a report from the American Hospital Association (AHA) and ONC from August, while nearly all hospitals said they have the infrastructure to exchange data, just one-quarter of them nationwide are finding, sending, receiving and using data electronically.
Also, hospitals’ rates of conducting different types of interoperable exchange vary, according to that report. Seventy-eight percent of respondents said they are able to send patient summary care records; 56 percent can receive them; 40 percent can use them; 48 percent can find health information from outside sources; but just 23 percent can do all four of these interoperable exchange activities.
So, considering that DeSalvo said the idea is to connect all HIEs in the country in the next year, certainly providers would have to be doing most, if not all of these four data exchange capabilities, right? Clearly, there is some sort of disconnect here when you also consider that providers have thrown their arms up asking for faster results for all the money that has been spent on health IT. Is this what they really want—goals that are too lofty to be accomplished? I doubt it.
What’s more, HIEs have yet to prove themselves as widely beneficial across the range of care settings, although research has shown them to be useful in emergency departments. Last December, a study from the well-known research organization RAND Corporation found that a lack of evaluation of the more than 100 health information exchanges across the U.S. has simply made it difficult to determine the benefits of HIE so far. The relatively few exchanges that have been examined show some evidence of reducing emergency department costs and usage, but other outcomes are unknown, according to the analysis, which looked at findings from 38 different studies. Barriers to HIEs include technical and workflow issues, costs, and privacy concerns, the researchers found. While that was a year ago, I am very skeptical that any—let alone all—of those major issues have been solved yet, or will be solved by the end of 2016.
At the time of that RAND study, I blogged about being patient with HIEs. I said that we don’t really know much about their benefits yet, but what we do know is that it’s too early to jump to any conclusions one way or the other. These types of major technology and process changes do not happen overnight, or even over a year—it’s a several-year process.
Today, I still feel that way. I also still believe that HIEs have real benefits that will be proven out down the road. That’s what made DeSalvo’s statement so perplexing to me. Perhaps her intent was worded wrong, or heck, maybe it was even interpreted wrong. But I will say this—if Dr. DeSalvo truly did mean that she wants complete HIE connectivity within the next year, she is very likely going to have to eat her words.
Do you think this is a realistic goal set forth by ONC? Feel free to comment below or follow me follow me on Twitter @RajivLeventhal.