Upon entering a doctor’s office, one can always be sure that there will be mounds of paperwork to fill out — paperwork that one has often filled out in other offices a dozen times over. However, there appears to be an alternative: University researchers are now examining how some organizations are computerizing, storing and sharing health information to avoid such redundancies.
Julia Adler-Milstein, an assistant professor in the School of Information and School of Public Health, is leading a study to determine how health information exchange efforts operate. David W. Bates of Brigham and Women’s Hospital and Ashish K. Jha, professor of health policy and management at the Harvard School of Public Health, are also involved in the research.
A University press release said health information exchange efforts were “deemed a national priority, and $548 million from the 2009 American Recovery and Reinvestment Act was devoted to helping states establish them.”
Adler-Millstein and her team compiled a list of all organizations in the United States that exchange clinical data by conducting three national surveys between 2007 and 2010. The results of these surveys were supplemented with information from the State Health Information Exchange Cooperative Agreement Program’s website, and plans made by individual states describing health information exchange activity.
Ultimately, 322 organizations were identified. However, further research determined that only 221 of the original 322 organizations met the criteria to be considered “operational” or “planning” to HIE.
Though the study reported 119 HIE efforts actively exchanging healthcare data among organizations in 2012, HIE still has a long way to go.
More than half of these operational HIE efforts are funded by federal grants, and the process of developing a sustainable business model that will support these efforts after federal money runs out has proven to be more difficult than expected.
“The (exchanges) that are self-sustaining focus heavily on the exchange of test results, because it’s clear that those are of value to doctors … it’s clear who benefits and who should pay,” Adler-Millstein said. “But with entire medical records, value is very confusing.”
There is no formula to determine who should pay for the costs of further implementing HIE. There are also complexities that arise from a technical and governance perspective — regulations are in place to protect patient privacy, and these have to be worked out before HIE can see widespread implementation.
Another difficulty arises in the form of competition between healthcare centers, many of which are reluctant to give patients an instrument that will make it easier to move between providers. Additionally, hospitals bring in more revenue if they conduct their own medical tests and diagnoses and so could lose revenue if they could automatically receive results from other centers or insurance companies.
“The fear is that health information exchange might make it easier for patients to move between settings,” Adler-Millstein said. “Hospitals see data as tying patients to their hospital.”
Traditionally, doctors have not had access to patients’ entire medical histories but with the potential to know every detail of a patients’ health, Adler-Millstein said that the new information gives way to liability issues as doctors might be less forgiven for making mistakes.
The University’s medical center is a participant in the Great Lakes Health Information Exchange, Eaton Rapids Medical Center and Clinton Memorial Hospital.
Adler-Millstein discussed the finds of the study at a National Press Club briefing in Washington D.C. on Tuesday. Her paper entitled “Operational Health Information Exchanges Show Substantial Growth, But Long-Term Funding Remains A Concern” was also released Tuesday on the Health Affairs website, and will appear in the August issue.