There is nothing more important in my role as CIO than ensuring that our clinicians have the right information to treat their patients when they need it. This underlies the importance of health information exchange. Health information exchange also may provide the opportunity to "bend the cost curve by avoiding duplicative testing, but enhancing care of our patients is paramount.
We have certainly come a long way since Dr. David Brailer, in his role as National Coordinator of Health IT, issued the challenge in 2004 to develop ways to exchange clinical information, and since 2009, when the HITECH Act offered significant incentives and direct funding for the meaningful use of electronic health records. State and local exchanges have formed, and some are operational. Provider networks have similarly introduced enterprise exchanges, connecting their closely aligned providers and establishing a link to the larger community.
Despite this progress, we are still only at the beginning of this journey, and many problems remain to be solved. What is the optimal exchange model for a particular community? How do we pay for it? How do I ensure the privacy of patient information? How can we assure clinicians that they are looking at the right patient's record and that the record is accurate?
The original vision for information exchanges was quite straightforward—all information on all patients would be stored in providers' electronic records and would be accessible through a shared community network. While that vision is largely unchanged today, significant variation is occurring in the delivery model. Emerging models across the nation, while true to the vision, range from the community utility providing all exchange services, to enterprise exchanges linking to one another directly or through a utility exchange.
Recognizing that care models are local (just like patient care), the Office of the National Coordinator has acknowledged the diversity in encouraging continued progress. The ONC is not supporting the dominant vendor model, which has emerged in a number of communities, and this is reflected in the proposed rules for Meaningful Use Stage Two.
The Health Insurance Portability and Accountability Act has provided baseline expectations and enforcement around the privacy of protected health information. The sharing of information across organizations brings new challenges and invites patients directly into the debate. Is advance patient consent (opt-in) required, or will patients' data be populated to the health information exchange unless they object (opt-out)? Privacy advocates recommend the opt-in option for stronger protection of patient information.