The State of HIEs

On Tuesday, Jan. 26, I attended the eHealth Initiative’s Annual Conference in Washington, D.C., which was quite lively and thought provoking. Here are five quick observations:

1. Won’t Get Fooled Again
This is the third time I have gone to a conference at which someone from the Office of the National Coordinator for Health IT was scheduled to speak, and it is the third time I have come away somewhat disappointed. I don’t think I’ll bother making an extra effort to go to their conference presentations anymore. Don’t get me wrong, ONCHIT’s staff members seem to me earnest, hard working, and intelligent. But their presentations at conferences like this one strike me as too basic and very cautious. It’s sort of like listening to President Obama’s press secretary, Robert Gibbs. I always get the impression he’s trying to answer questions without really saying anything. This crowd didn’t need to hear a rehash of what the basic components of meaningful use are or what a regional extension center is, but that’s about all they got from Joshua Seidman, acting director of the meaningful use division (nice title, huh?).

2. States: Revenues Down, Uncertainty Up
During a panel about state health information exchange efforts, Ree Sailors of the National Governors Association noted that in 2010 many state governments are facing a double-whammy of sharp revenue declines and the prospect of turnovers in the governor’s mansion. On the financial side, overall state revenues are down 17 percent from a year ago, forcing cuts in critical services at the same time there’s going to be an influx of HITECH funding to foster eHealth improvements. Meanwhile, in this fall’s elections, there’s the potential for a 50 percent turnover in governors, said Sailors, director of health IT in the NGA’s Health Policy Division. Those changes in administration are bound to disrupt or slow work on HIEs as new governors, staffers agency heads and legislators struggle to get up to speed, she said.

3. You’re Never Done Building Trust
People in regions that don’t yet have functioning health information exchanges may look jealously at places like Cincinnati, where the HealthBridge HIE is seen as a model of success, with links to 24 hospitals and more than 5,000 physicians in three states. Yet even for advanced HIEs, the organizational work is still challenging. Rodney Cain, HealthBridge’s CIO, expressed some frustration when asked how HIEs could move from just being a medium for exchanging data to getting involved in more advanced projects like quality initiatives. As HealthBridge recently began work on a project to consolidate regional data for reporting to CMS, it found it needed to go back to some providers for missing data elements, he said, and met with resistance. “It felt like we were starting over,” Cain said. “Sadly the same old issues of trust between institutions popped up.” The issue of building trust is ongoing, he said, and is constantly evolving due to the pressures of the marketplace, meaningful use, and interoperability.

4. Can HIEs Be Done on the Cheap?
At the conference, the eHealth Initiative announced winners of its 2010 eHealth Awards. One was Larry Garber, MD, the medical director for informatics of the Fallon Clinic in central Massachusetts. After hearing other state-level health IT leaders give their take on how HIEs might achieve financial sustainability, Dr. Garber said the key is to keep the overhead as low as possible. He said the software for the SafeHealth HIE he has helped establish in Massachusetts was written in-house. There is no legal entity set up, so they avoided attorneys’ fees. The annual operating expenses so far, he said, are just $7,000 per year. Is that a model others could replicate?

5. Trying to Tackle Too Much at Once
During the wrap-up of a panel on transforming patient-provider relationships through eHealth, two prominent physicians expressed some doubts about the expansive scope of the meaningful use push. While expressing their support for the overall goals, both Steven Stack, MD, a member of the board of trustees of the American Medical Association, and J. Leonard Lichtenfeld, deputy chief medical officer of the American Cancer Society, said the Stage 1 MU guidelines are putting way too much on the table at once. Stack said an approach he would prefer would be to first tackle a smaller list of projects to solve specific problems about making e-prescribing and lab and radiology data ubiquitous. Lichtenfeld said the expansive nature of the MU guidelines could be problematic for many physicians who believe they don’t have the time, money or expertise to comply.

One last bit of news from the conference: Harry Totonis, president and CEO of Surescripts, announced that his company would begin working to make prescription history information available to HIEs as well as to patients’ personal health records.