Data silos remain one of the prime obstacles to care coordination, ONC told Congress

ONC reports on EHR progress, pitfalls

By Anthony Brino
04:09 PM
In its annual report to Congress, the Office of the National Coordinator for Health IT outlined some of its milestones and how it's trying to fix some barriers to main goals of the HITECH Act, chief among them nationwide digital exchange through interoperable EHRs.
Amid the health IT challenges ONC acknowledged in its report — costs, workflow and usability concerns for some physicians, and exchange limitations for some hospitals — the past year also saw some criticism of meaningful use, with six Republican Senators calling for a “reboot” of the program.
Notwithstanding those and other challenges (which might be dissected in depth during possible Congressional hearings this summer), ONC told Congress members that the stage is set for long-term progress.
In 2012, nearly 75 percent of office-based physicians had adopted an EHR, with 40 percent having some advanced functionalities Those doctors achieved at least 50 percent adoption rates for 12 of the 15 meaningful use stage 1 core objectives.
Among hospitals in 2012, 85 percent were using a certified EHR, up 18 percent from 2011, and 84 percent of critical access hospitals have registered for stage 1 EHR incentive payments.
Digital documentation does not go very far without the ability to exchange patient data, however, and indeed data silos are one of the prime obstacles to care coordination, as ONC admitted to Congress. “Enabling exchange will involve reducing the cost and complexity of electronic health information exchange, ensuring trust among the key participants of exchange and encouraging exchange of information, particularly during transitions of care.”
As an office within a much larger agency, the Centers for Medicare & Medicaid Services, ONC told Congress it’s helping to make interoperability progress through a number of policies and programs — among the forthcoming ones are meaningful use stage 2 requirements for health information exchange.
Even as stage 1 was getting underway (and stage 1 did not emphasize or necessarily require interoperability), the state HIE program helped expand digital health exchange at the local and regional levels. And through a recently-issued RFI, CMS and ONC are also taking suggestions on how to expand interoperability through incentives, payment adjustments and requirements.
In the long-term, ONC is coordinating the development of industry standards, with the goal to “reduce the cost and complexity of exchange” while ensuring patient privacy. The ONC also launched the Exemplar Health Information Exchange Governance Entities Program, a cooperative agreement to help develop existing health information exchange governance models, with grants awarded to Direct Trust, a nonprofit devoted to secure exchange, and the Interoperability Workgroup, a New York eHealth Collaborative-led coalition.
The commonly-adopted approach of Directed exchange, ONC explained to Congress, “is often less expensive to implement and operate than more complex types of exchange, and allows healthcare providers (and consumers) to retain control over who receives health and other personally identifiable information.”
As of December 2012, 39 states and U.S. territories have operational directed HIE available on a subscription basis for providers and nine states have it available in regions or pilots. Twenty-five states and territories have query-based exchange available statewide, and 11 states have query exchange in regions.
For some examples of the potential investment returns of health IT, and the broader goals of the HITECH Act, the ONC pointed to results from some of the Beacon Communities, a $250 million program offering 17 consortiums across the country funding for IT tools to address chronic condition management and new care models over three years.
The ONC is in the process of collating lessons learned from the Beacons — and there were failures and successes, early data shows — and shared some examples with Congress.
Between 2010 and 2012, the Bangor Beacon Community, in the north-central Maine city of Bangor, 65 percent of cardiovascular disease patients showed control of their LDL cholesterol, while high-risk patients saw hospital admissions rates decrease from 26 percent to 16 percent and the emergency department visit rates decrease from 26 percent to 17 percent.
The San Diego Beacon Community likewise saw inpatient readmission rates decrease from 18 percent to 13 percent among complex-needs patients after the implementation of a four-week care transitions initiative.
In short, health IT is making slow and steady progress in pockets of the country where it’s being put to meaningful use, the ONC told Congress.