Study Provides Important Lesson Regarding HIEs
By Christine Kern, contributing writer
An ONC study examined the development of six state HIE programs in wake of the HITECH Act.
The ONC has released the findings of a case study – The State HIE Program Four Years Later: Key Findings on Grantees’ Experiences from a Six-State Review – examining the progress of state health information exchange programs, detailing the efforts of six states, and finding both progress and gaps in the pursuit of interoperability.
Ultimately, the study found that although the six states studied – Iowa, Mississippi, New Hampshire, Utah, Vermont, and Wyoming –faced significantly different challenges as a result of their unique populations, presence of large-scale health systems, and wide range in geographic differences, the HITECH-funded State HIE Cooperative Agreement Program has created the appropriate basis for the exchange of health information, with states playing an integral role in leadership, collaboration, policy development, and identifying local health IT gaps.
The Office of the National Coordinator for Health IT established the program in 2009, providing $564 million in funding and guidance for states to establish secure and interoperable electronic information exchange. ONC also contracted with NORC at the University of Chicago to conduct a multi-year assessment of the program.
In an ONC blog post, Matthew Swain, Kory Mertz, and Kristina Celentano explained “context was a major factor in how these grantees organized and operationalized their respective programs.” Approaches varied from state to state, out of necessity, and, “Although this finding may appear self-evident, accounting for local context is critical when designing technical, behavioral, or policy solutions to advance interoperable HIE.”
“Put another way, what works for Iowa may not work for New Hampshire,” they concluded.
The study also uncovered “the need to set tangible and achievable immediate goals that keep stakeholders energized,” the importance of collaboration among those taking part in an HIE, and “leveraging a variety of policy and regulatory levers to advance the interoperable exchange of information.”
Not surprisingly, each of the six states experienced IT-related challenges, from EHR and HIE developer limitations to lack of interoperability between systems and data capture and quality issues, the study found.
Although the analysis offers an indication of the impact of large-scale data sharing efforts, the authors conclude it remains “only a small part” of the national landscape, Med City News reported.
According to the RAND Corporation, which conducted a recent systematic review, there remains “a paucity” of studies analyzing HIE use and impact, making it “important for entities that share electronic health information to study and understand how HIE effects clinical and non-clinical processes and outcomes,” the ONC wrote.
The study asserts that “understanding the impact of the of the State HIE Program four years after HITECH is essential as states move forward with expanding their HIE efforts and leveraging existing infrastructure for healthcare and payment reform efforts.
“The insights presented in these case studies may assist other states and policymakers in their ongoing HIE efforts, and identifies areas where important work remains to fully realize the benefits of HIE and to support healthcare and payment delivery reform efforts.”
“Stakeholders believed it is too early to tell what kind of long-term impact the program has had on exchange [of health information], given the difficulty of measuring impact from the multitude of factors involved,” according to the case study. “However, they did feel that the value of program efforts would increase over time with support from new care models, such as ACOs and Patient Centered Medical Homes, and new payment models.”