ONCHIT looks for HIE silver lining amidst budget constraints, technology timidity
ORLANDO–To build sustainable health information exchanges (HIEs) in the United States, many technological and governmental barriers still need to be overcome, according to a presentation today by Kelly Cronin, director of program and coordination at the Office of the National Coordinator for Health Information Technology (ONCHIT).

Cronin opened the third RHIO symposium held at the 2008 HIMSS conference today by acknowledging that ONCHIT has recently received a great deal of scrutiny for their lack of progress with HIEs.

Cronin said their current challenges to implementation are value proposition, proving the economic value to those who have the power to fund the transition; governance at all levels, which she continuously stressed as a necessity for implementation and sustainability; and competing models of data exchange.

To track the current progress of HIEs in the United States, she presented the findings from the eHealth Initiative (eHI) 2007 survey, which found that there are 125 initiatives reported according to stage of development. Most importantly, 32 of the initiatives are in an operational stage of five, six or seven, according to the eHI survey. The results also found that in 2006, there were 15 percent fewer participating than in 2006, 25 percent are dependent on grants, and 75 percent rely on results delivery.

In terms of funding, hospitals are funding 30 percent of overall HIE programs, and 75 percent of the advanced programs. More specifically, in the 32 advanced models, 56 percent of the 2007 funding came from hospitals, compared to 54 percent in 2006.

Based on the eHI survey, the largest funding adjustment for the advanced programs came from support from payors. The 32 advanced HIEs received 46 percent of funding private payors, compared to 19 percent in 2006; and the same programs received 38 percent from public payors, compared to 18 percent in 2006.            

The major challenges facing all HIEs have remained the same over the previous two years: developing sustainable business model; securing funding; defining value for users of the HIE; privacy; and engaging clinicians.

In response to the final challenge, Cronin stressed the importance of engaging clinicians, and convincing them it will benefit them as well as the patient.

Cronin presented some potential solutions to the overarching problems plaguing HIE implementation. For the sustainability of HIEs, Cronin acknowledged that there is “no silver bullet model,” but added that “we need to be market savvy and develop HIE services that meet a customer need and deliver value.” To overcome the challenge of value proposition, Cronin said that HIEs can produce cost savings from decreased redundancy and enable quality improvement and Medicare payment reform by making clinical (not just claims) data available for performance measurement and reporting.

However, Cronin said there is no obvious demand for HIEs with the current reimbursement system, and successful RHIOs are inducing demand by providing services that demonstrate value.

Throughout her presentation, Cronin said that collaborative governance across jurisdictions is needed. “We don’t really have one right now due to limited resources, so there is no oversight mechanism in terms of governance,” she added.

To advance the governance of HIEs, Cronin said that a national level governance needs to be established; effective governance models at state levels need to be promoted; and oversight mechanisms need to be considered, such as accreditation to support interoperability.

“We want to support the formation of statewide agendas, or forums. These forums will foster better understanding and coordination of many separate, but related projects to advance HIE, including HISPC, HITSP, NHIN, CCHIT and AHIC 2.0,” according to Cronin.

She said that an environment of change needs to fostered within ONCHIT because the continuity of leadership is needed to sustain the momentum gained over the past 24 months, and in particular because the government changes every four years. She said that upcoming elections lead to an uncertainty about new leadership that places momentum at risk due to budget restraints.

In regards to the change, Cronin addressed the restructuring of AHIC to yet-to-named, AHIC 2.0. About the current thrust in the development of the proposed private-public AHIC 2.0, she said that the entity should: exist for the purpose of the individual/consumer benefit; establish and enhance trust among stakeholders; have broad participation across the healthcare industry stakeholders; provide continuity (accelerate and coordinate current AHIC interoperability initiatives); provide strong leadership; and construct and champion a balanced view.

“Everyone recognizes the need for the internet and the need for health data exchange, but we also need to be realistic about our time constraints,” Cronin tried to encourage her colleagues.
“The ultimate reason for health IT [is] the quality of health we want and deserve. And we [at ONCHIT] are all excited and frustrated at the same time, and hopefully, we can build on the momentum from the past year, and make this year, a year of change.”