Though people are passionately discussing health information exchanges and health insurance exchanges today, it is important to recognize that the vision for all Americans to have access to electronic health records (EHRs) by 2014 began in 2004.
At that time, President George W. Bush established the position of National Coordinator for Health Information Technology within the Department of Health and Human Services and laid the foundation for a Nationwide Health Information Network (NHIN). The goals of the NHIN are seamless connectivity and secure exchange of healthcare information nationwide. It is neither a national network nor a bunch of servers run by the federal government. Instead, it is a set of standards and tools developed by a core group with significant experience in building health information exchanges (HIEs).
Federal agencies such as the Department of Defense, the Centers for Disease Control, the Veterans Administration, and the Social Security Administration; states such as Delaware (home to the nation's first statewide health information network), New York, North Carolina, Virginia, and West Virginia; educational institutions such as Indiana University and Wright State University; and private healthcare organizations such as Kaiser Permanente and the Cleveland Clinic were among the initial participants in the NHIN.
Technology to build HIEs, initially developed by federal agencies, was released to the public domain in the form of CONNECT, a free, open-source software solution that lets anyone build HIEs and connect to the NHIN. An organization can build an HIE to communicate between internal EHR systems, join an HIE, or communicate with EHR systems of other organizations.
Since 2010, significant work on state HIEs has been done as a result of financial incentives authorized by the HITECH Act of 2009. Thirty-four states and the District of Columbia received first-round funding to build HIEs. Some state HIEs, including Maryland's, have connected all hospitals and progressed to the second stage of funding for operations, but some early innovator states actually returned the federal money and held back work on the exchanges.
Since the same acronym has often been used for both types of exchanges, health information exchanges can be confused with health insurance exchanges. Perhaps a new acronym for the insurance version -- HIEX -- will solve this problem. This type of exchange, a requirement of the Affordable Care Act (a.k.a. Obamacare), is designed to allow anyone to compare options and enable them to buy affordable health insurance. The concept is very similar to an electronic securities trading organization, which democratized stock trading and allowed small investors and individuals to get quotes and buy stocks and other securities at affordable trading fees.
HIEXes must be functional in states by 2014, and states must make their intentions known by Dec. 14, 2012. Several states have received funding to build state-run HIEXes. But bills to establish these exchanges have failed in many state legislatures. Other states, such as South Carolina, are opting to use the default federal government-run HIEX. Though the uneven implementation has raised concerns, the Obama administration has said insurance exchanges will be functional in all 50 states and DC by 2014. Perhaps another benefit of several federally run HIEXes will be a speedier path to a nationwide Health Information Network.
Mansur Hasib has served in CIO/CISO and other leadership roles in the public, private, and education sectors.