GAO chides HHS for lack of health information exchange milestones

HHS needs to “develop and prioritize specific actions” consistent with its strategy to promote health information exchange and “develop milestones with time frames for the actions to better gauge progress toward advancing exchange,” a Government Accountability Office report recommends.

The GAO notes that HHS has a health IT plan: The department, the CMS and the Office of the National Coordinator for Health Information Technology at HHS collaborated on a 2013 update of a national health IT strategy. The plan includes a description of principles that will guide future actions to advance exchanges, the GAO authors said. “However, the HHS strategy does not specify any such actions, how any actions should be prioritized, what milestones the actions need to achieve, or when these milestones need to be accomplished,” the GAO said.

“As noted in GAO's prior work,” the report continued, “elements such as specific actions, priorities and milestones are desirable for evaluating progress, achieving results in specified time frames and ensuring effective oversight and accountability.”

The 44-page GAO report, “Electronic Health Records, HHS Strategy to Address Information Exchange Challenges Lacks Specific Actions and Milestones,” was written after interviews with hospital officials and physicians in four states, along with officials from HHS, regional extension centers, health information exchanges, vendors and several national organizations about their HIE experiences.

It's not that the GAO auditors didn't recognize the difficulties of health information exchange.

“Several providers stated that they often have difficulty exchanging certain types of health information with other providers that have a different EHR system due to a lack of sufficient standards to support exchange,” according to the report.

The GAO noted that Stage 2 of the EHR incentive payment program specifies EHR certification criteria that specify standards to support exchange, such as those needed to transmit and receive a summary of care record, called the Continuity of Care Document. It also highlighted ONC's work on the Direct Protocol for the transportation of encrypted messaging between providers. But the GAO noted those standards don't support “more robust exchange.”

Several interviewees wanted more HHS effort applied to address the problem of accurately matching patients to their records (in absence of a federally banned, national patient identifier.)

HHS concurred with the GAO's recommendations, saying it has begun to develop and prioritize specific actions, and develop milestones with timelines, the report authors said.

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