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Update on Health Information Exchange

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Health Information Exchanges are the offspring of the failures of numerous RHIOs due to unsustainable business models. They are the same horse of a different color.

HIEs were empowered by the sequence of events beginning with George Bush appointing David Brailer MD to develop ONCHIT by executive order. It was then approved by Congress and funded as a regular agency. The passage of HITECH and ARRA (stimulus program) incentivized electronic medical records and Health Information Exchanges.

The February 1, 2012 meeting of the Health IT Policy Committee was provided with an update of the current status of the State HIE Program, as well as an update on the standards work and development of the NwHIN and Direct Project. This is a fascinating review and if you are interested in health information exchange, you should take the time to watch this. I believe it offers some hints towards the upcoming rule on NwHIN governance and the health information exchange requirements for Stage 2 meaningful use. Below is the presentation to the committee by Claudia Williams, ONC’s state HIE program director, and Dr. Doug Fridsma, director of ONC’s Office of Standards and Interoperability.

Slide share Presentation

Despite more than 8 years since the concept of RHIOs began and significant financial incentives as well as penalties for non compliance the adoption of HIE has been slow. HIEs develop slowly often because of financial uncertainty, lack of sustainable business models, and other factors.

These other factors include the realization by hospitals and providers that this added feature will increase cost and at the same time thus far has not demonstrated any return on the investment.  Perhaps this will change with time and the burden of paperwork, faxes and time required to obtain medical records decreases.

However, the record is not good. Measures of ROI thus far do not demonstrate decrease in costs. As the network increases there will be hardware maintenance, software developments and upgrade expense to add to the cost escalator.

CMS and HHS have funded EMR and HIE incentives with the agenda to recapture the taxpayer’s dime extracting information such as outcomes and treatment protocols in real life hoping it will decrease cost in the long run.  A large and risky bet, however it’s your money….However your practice, doctor is not too big to fail.


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