Debate over HIEs Intensifies as Some See Doom on the Horizon

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The debate over Health Information Exchanges (HIEs) is only intensifying, reports Ken Terry at InformationWeek Healthcare, with many questioning “the viability and usefulness of the current generation of HIEs.”

William Yasnoff, MD, PhD, president of the Health Record Banking Alliance represents the fiery side of the HIE debate. In an article for NHINWatch, he said, “It’s time to face the facts: Our nationwide network of Health Information Exchanges (HIEs) is an unmitigated disaster.”

It should be noted that Yasnoff’s criticisms might be a little self-serving given his organization and its support for an aggregation of records into a patient-controlled regional database (also known as health record banking). The HIE will do the opposite, employing several databases with no central storage.

Terry writes, “Yasnoff pointed out that, three years after ONC (the Office of the National Coordinator of Health IT) began to invest over half a billion dollars in statewide HIEs, 90 percent of hospitals in 32 states have yet to exchange a single patient record. He cited a 2011 study showing that of 179 HIEs, only 13 were capable of helping providers meet Meaningful Use stage 1 criteria for interoperability. And he noted that most HIEs have yet to overcome the key obstacles of ‘privacy, stakeholder cooperation, and financial sustainability.’”

Yasnoff believes there is serious potential that the national HIE will suffer from a “failure of interoperability.” He also thinks it’s “too complex and expensive, prone to error, insecure and unable to guarantee privacy, not financially sustainable, and unable to assure stakeholder participation, because HIE participation is voluntary.”

Yasnoff isn’t a lone wolf on these views. Expressing similar concerns is John Loonsk, MD, chief medical officer of CGI Federal and a former ONC official. “Recent, non-political Congressional testimony” has led him to believe that “interoperability is still another decade away.”

But he thinks that this is too optimistic since every hospital is integrating with different EHR platforms. It’ll be longer than a decade, Loonsk says.

Michael Matthews, president and CEO of the MedVirginia HIE and president of Healtheway, is a bit more optimistic than his colleagues.

“I do see some serious progress around population health, best practices, clinical outcomes, accountable care, and aligning incentives,” he said. “And all of a sudden it may be worth that additional step it takes to access all the information on a patient, not just the information that’s in my own medical chart. So that encourages me that we still have work to do, but the economic drivers will start to support that.”

It’s not EHRs causing the problems, he adds. It’s physician workflow and convincing doctors “to change workflows that currently work for them. Disrupting that flow for a patient here or there is not conducive to taking advantage of the information that’s available through an HIE.” But even here, he sees major resolutions within “the next two years.”

Are you as pessimistic about HIEs as Yasnoff and Loonsk? Or do you lean more in Matthews’ direction, acknowledging that change always has its bumps and bruises, but eventually works out? What advice would you give the ONC about improving the switchover to HIEs?

-by Pete Fernbaugh

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