Five EHR companies said they would launch a not-for-profit corporation called CommonWell Health Alliance to operate a shared, centralized platform for patient and provider identification and authorization. A record-locator service would identify which participating providers have records in their EHR systems for specific patients. The initiative, they said, would create a system for “simple patient-centered management of data-sharing consents and authorizations.” That effort, though, omits some major players, including Epic Systems Corp.
Nearly 207,000 physicians and other “eligible professionals” and 3,663 hospitals have been paid nearly $11.8 billion as adopters or meaningful users of EHRs under the federal programs created under Medicare and Medicaid by the American Recovery and Reinvestment Act of 2009.
Progress on moving electronic health data, though, is a mixed bag. Mostashari said the percentage of hospitals that have electronically exchanged clinical-care summaries with outside hospitals rose from 7% in 2008 to 24% by 2012.
“Twenty-four percent is nothing to celebrate, even though it's triple where it was before,” Mostashari said.
Soon—Oct. 1 for hospitals and Jan. 1, 2014, for physicians and other professionals—providers that have already met two or three years of Stage 1 meaningful-use requirements will have to meet the new, more stringent Stage 2 meaningful-use criteria. That means even more interoperability will be required—not only from provider to provider, but also from providers to patients.
Mostashari promised the government will “use every tool at our disposal,” including payment reforms, regulations and “the bully pulpit” to see those percentages rise. To help, he said, the federal government wrote 43 building blocks of health information exchange into the certification requirements for EHR systems. Vendors must meet the specifications to sell their wares to providers trying to meet the Stage 2 meaningful-use criteria for incentive payments.
The five vendors that created a buzz in New Orleans with the announcement of CommonWell were Allscripts, Athenahealth, Cerner Corp., Greenway Medical Technologies and McKesson Corp., as well as McKesson's connectivity subsidiary, RelayHealth. They did not disclose their financial commitments to the project, which the founders said will be open to other IT companies.
Leaders of several other major vendors, including Carl Dvorak, president of hospital and ambulatory care EHR developer Epic Systems, and Dr. Vishal Agrawal, president of healthcare solutions for systems integrator Harris Corp., said they had not been asked to participate. Also omitted was eClinicalWorks, a popular EHR system for office-based physicians.
Healthcare providers, meanwhile, are making progress on information exchange through regional networks. HIMSS attendee Dolph Voelker, director of information systems for Indiana University Health hospital in Goshen, Ind., said he thinks they're ready for Stage 2 interoperability. “We have a pretty good groundwork laid for that,” Voelker said.
The 122-bed northern Indiana hospital connects to about 150 employed and independent community physicians using multiple vendors' EHRs through the Michigan Health Information Network, a regional health information organization. The Michigan RHIO in turn provides connectivity to healthcare organizations throughout Indiana with a connection to the Indianapolis-based Indiana Network for Patient Care, run by the Indiana Health Information Exchange.
Voelker said it made sense for Goshen and several nearby Indiana hospitals to join the southern Michigan-based exchange because many of their patients move across the border for care. It is a an operational example of the “network of networks” configuration of a Nationwide Health Information Network first proposed by Dr. David Brailer, the first head of the ONC, in 2004.
“The vision is to have our data shared between these health information exchanges,” Voelker said. “They're starting to communicate with each other.”