Influencing Policy: Policy Imperatives

The following summarizes a series of steps that are needed to support and accelerate the mobilization of data to support patient care through health information exchange across the United States.

Without the alignment of financial and other incentives with both quality and efficiency goals as well as electronic health information exchange capabilities, efforts to accelerate the mobilization of information to support patient care will continue to move at a slow pace. Achieving ongoing sustainability was cited as a significant challenge by 31 percent of all respondents, and 84 percent cited this barrier as either a very difficult or moderately difficult challenge. Recent efforts by members of Congress, the Administration and the private sector hold promise for beginning the migration of our outdated payment system to one which rewards quality and efficiency goals and the processes and functions (such as health information exchange) that support their achievement.
Innovative programs designed to facilitate public and private sector seed funding of emerging health information exchange efforts must be developed and implemented if goals related to widespread interoperability are to be achieved. Securing upfront funding is the most challenging issue for health information exchange initiatives and organizations, with 59 percent of all respondents citing “securing upfront funding” as a very difficult challenge and 91 percent citing this barrier as either a very difficult or moderately difficult challenge. While federal efforts can play a critical role in addressing this challenge, they should be designed to stimulate investment by the private sector as well as state and local government agencies to facilitate widespread interoperability.
More work is needed to support the engagement of the multiple and diverse stakeholders within healthcare in health information exchange efforts, including consumers, laboratories, health plans, purchasers, and consumers. Of all constituencies, providers are playing the most visible role in the governance of HIE efforts, with survey results revealing that hospitals (61 percent), primary care physicians (48 percent), specialty care physicians (37 percent), and community health clinics (35 percent) are involved in the governance in these efforts. The survey data also shows that while there is a trend toward including other stakeholders in these efforts, more work is needed to continue to engage their involvement. For instance, survey results reveal that only 37 percent of health plans, 27 percent of employers or purchasers, 26 percent of patient or consumer groups, 12 percent of healthcare IT suppliers, and 7 percent of laboratories are currently engaged in the governance of health information exchange efforts.
States are increasingly becoming involved in health information exchange efforts, however their role should be expanded and clarified. Increasingly, states are playing a role in supporting the work of local efforts related to health information exchange within their boundaries with 53 percent of all respondents indicating state involvement. The state can play a pivotal role in either promoting or impeding the progress of health information exchange initiatives. Given their multiple roles as purchaser, payer, regulator, and funder, their participation and support of these efforts is critical. More work needs to be conducted to explore and define an expanded role for states.
National efforts designed to achieve consensus on and promote the adoption of standards could not be more timely. Currently health information exchange initiatives are in the midst of engaging in the difficult work related to getting organized; engaging stakeholders; defining goals, objectives, and priorities; and developing sustainable business models. As this work continues to migrate towards the implementation of technical networks, leadership on both the development of new and communication of the many existing standards at the national level by both the federal government and the private sector will be critical, to enable interoperability across markets.

eHI is using the 2005 survey results to continue its work with leaders at the state, regional and community levels to build multi-stakeholder collaborations focused on mobilizing healthcare information across organizations to improve the quality, safety and efficiency of care. eHI is incorporating the survey findings and recommendations into a rich set of tools and resources to support the various aspects of health information exchange and the results will be shared for use by the more than 100 state, regional and community-based health information exchange initiatives across the United States.