Experts see future as both intriguing and aggravating
SEATTLE – The ever-increasing ability of both doctors and patients to send and receive healthcare data on the move is adding some weight to the health information exchange debate, but issues remain with security and a reluctance to share information.
As a result, doctors aren't jumping on the bandwagon, HIE networks are struggling to remain sustainable and providers aren't investing in the necessary technology.
That's what makes this both an exciting and a challenging time to be in healthcare, said Lynne Dunbrack, program director for IDC Health Insights, who chaired a panel discussion on HIEs to kick off the Institute for Health Technology Transformation's conference last month in Seattle.
And while Dunbrack pointed out that the HIE space is one of the fastest growing and most dynamic markets in healthcare, panelists like Brian Ahier, a health IT evangelist for Mid-Columbia Medical Center, said the market won't take off until its participants learn to share.
"Successful organizations are no longer going to seek a competitive advantage," he said. “They are going to seek a cooperative advantage."
As the nation moves forward with healthcare reform and the concept of accountable care and patient-centered healthcare, its disparate parts are going to have to come together and share information in different formats and locations, from the rural clinic with a telemedicine program to the housewife trying to update a child's PHR to the physician seeking a consult via an iPad to an insurer making sure a member is getting the proper follow-up care after leaving a hospital.
"It's a fundamental aspect of accountability that you have to know what's going on," pointed out Greg Fraser, MD, chief medical information officer for the WVP Health Authority, a 500-member independent physicians association based in Salem, Ore.
But the ages-old "my-patient-my-data" philosophy still holds some weight in the provider community, where physicians and even some networks are wary of sharing data, for fear of losing valuable business.
"It's an issue of survival to them," said John McDaniel, a former healthcare CIO and consultant who's now the national practice leader in the U.S. healthcare provider market for NetApp. Added to that, he said, is the fact that providers are using electronic medical records and other systems from a variety of vendors, and those systems don't necessarily integrate with each other or follow the same standards.
"A lot of (providers) are holding onto their investments (in HIE technology) until some sort of standard arrives," said Jim Prekop, president and CEO of the healthcare informatics company TeraMedica.
With these issues on the table, some HIEs are struggling to survive. McDaniel pointed out that many states jumped on the HIE bandwagon when the federal government provided funding, but now that those funds are drying up, the exchanges are either struggling (California and Tennessee) or moving toward private HIEs.
"Sustainability continues to be an issue," said Fraser.
As do questions of ownership and responsibility, both compounded by the move to a patient-centered healthcare landscape. Betsy Boyd-Flynn, deputy executive vice president and COO for the Oregon Medical Association, said there will always be concerns over how healthcare data is used and by whom, particularly when its shared among different organizations. And many organizations are looking at the rising tide of data breaches and wondering when they'll be affected, rather than if they'll be affected.
"I keep waiting for someone to stand up and say, 'Wait a minute, your need for data does not trump my right for privacy,'" said Fraser. Too many healthcare organizations, he added, assume patient consent rather than asking the patient to release that information.
The conclusion? Among the panelists, the future is, as Dunbrack pointed out, both intriguing and aggravating. Healthcare information is out there and it's mobile, pointed out Paul Mathews, chief technology officer for OCHIN and a member of the Nationwide Health Information Exchange Coordinating Committee, and the question is how it will be shared, and with whom.