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.
Open standards are important with healthcare systems. The robustness of these systems are literally life-and-death matters; it's important that experts can see the code and evaluate whether it works as it should.
You make excellent points, Mitch, regarding the politics. Functionally, yes, the exchanges were started in advance of Obamacare, BUT most people ARE associating it with Obamacare. So the reality is that it will have a political flavor and those opposed will definitely be slow or resistant to joining the health networks.
You also make an excellent point, again recognizing the politics, that the full development of networks is not going to succeed until the physician/consumer acceptance is achieved. Most of the efforts now are still top-down and there are a lot of smaller medical groups and physicians who have not bought into the concept and don't see the need.
It's a real shame politics is involved in healthcare. It's also a shame money is involved. But since that's life in the big city (and the small village!), I think it's important that healthcare organizations, their IT departments, and government agencies -- along with insurance and all other stakeholders -- move as quickly yet safely as possible toward secure networks that can share information.
My orthopedist loves the EHR his practice uses; it's the one used by one of our three local hospital chains, and it allows him to look-up patients' records via his smartphone or iPad when they go to the ER and he gets a call. In the past, he told me, he either had to go to his office or - more likely - send one of his assistants, which cost him (then the patient and/or insurer) money to review the patient's chart for medications, history, etc. Now he looks them up on-the-fly, no matter where he is. Dr. O credits this with saving him countless hours and dollars since his office implemented it a year or two ago.
@Dhagar - I do believe the HIEXes will be formed. The HIEs are running well in many states and have already connected many silos. The promise of data for the betterment of public health outcomes is great.
@Kim - I am not sure I understand the question. We establish standards of practice and we issue certificates and licenses. Not sure why we would not establish standards in IT and information security and privacy.
@Alison - many HIEs started organically but if you will have networks communicate, you need standards and that is where collaboration and standards development was facilitated by the US government and incentives provided to soften the initial investments.
No one can argue with the value of exchanging healthcare information electronically. But is the current approach too centralized, too top-down, too rigid?
The ThinkerNet does not reflect the views of TechWeb. The ThinkerNet is an informal means of communication to members and visitors of the Internet Evolution site. Individual authors are chosen by Internet Evolution to blog. Neither Internet Evolution nor TechWeb assume responsibility for comments, claims, or opinions made by authors and ThinkerNet bloggers. They are no substitute for your own research and should not be relied upon for trading or any other purpose.
In all my years interacting with CFOs, I have not met one who actually understood IT -- not that I expected them to.
Why, then, do I continue to see ads seeking a strategic CIO who will report to the VP of Administration and Finance or the CFO? Sometimes ads are slightly better: CIOs report to the Chief Operating Officer. Those conducting the recruitment will sagely say: “The CIO will have complete empowerment and access to all cabinet members and the president.” However, these organizations appear to lack an understanding of the role of the CIO and the CFO.
After observing and writing about CEOs who do not leverage their CIOs to propel their organizations forward, it was very refreshing to learn about the great CEO/CIO partnership at Kaiser Permanente at this year’s World Health Congress held in Maryland.
Despite an initial round of federal funding to develop state health information exchanges (HIEs) as part of Obamacare, these clearinghouses were challenged to develop a financially sustainable model. Because it addressed sustainability early, the Delaware Health Information Network is viewed by many as a template for HIE success.
It began as a relaxing visit with my college buddy and his family. It became a glimpse into the technology-enabled future of worldwide collaboration in engineering.
True story: Despite the HITECH Act of 2009, the CEO of a major urban hospital continued his institution's policy of not hiring a CIO or CISO. Like many others, he took a wait-and-see attitude, even though HITECH strengthened the enforcement of healthcare security and privacy laws, and provided financial incentives for healthcare organizations to adopt electronic health records and information security.
If you listen to the hype, clouds are everywhere. But if you look at the data, it turns out most customers say they still wouldn't use cloud computing for mission-critical apps or data. What's holding them back? Fritz investigates.
ITRC found that more than 600 security breaches took place in 2012. Flaws were found in some of the nation's most respected companies: Apple, Citibank, and Wells Fargo. So, it seems the bad guys are doing better than the men in the white hats.
Healthcare providers have been moving to telemedicine treatments, where the patient and doctor can meet online, but insurance carriers are not required to pay for such treatments. This may change, though, as Maryland recently passed a law mandating that insurers pay up.
The plan for unmanned police drones to patrol traffic and other city conditions in Seattle has sparked a new set of legal concerns about privacy. Law traditionally lags technology, but we can expect now to see a new round of activity in the courts as legal definitions begin to emerge on what "next-gen privacy" will look like.
US counterterrorism expert Richard Clarke, who came to prominence with his prescient warnings before the 9/11 attacks, tells Smithsonian Magazine the US was responsible for the Stuxnet supersmart worm that attacked parts of nuclear reactors in Iran – and in the process, has given away one of the world's most sophisticated cyberweapons.
Dave Austin, communications director for Multnomah County, discusses why he's excited to move from the county's "old and clunky" intranet and onto an open-source platform, and how this change will help him do his job.
Jane Williams, technology training manager for Multnomah County, says the ability to share resources is just one of the coming benefits of moving the county's intranet to a Drupal Commons platform hosted in the cloud.
New York's Metropolitan Transit Authority is conducting a pilot test of digital kiosks to guide subway users to where they want to go more efficiently and at lower cost.
The whole Amazon.reader debate is a double-stupid. It's stupid to think that there's any e-book buyer who doesn't know Amazon's URL, and it was stupider to let ICANN launch the whole free-form TLD initiative to start with.
While NFC's original goal was to enhance mobile commerce applications, it is finding its way into a number of other uses, which is creating both opportunity as well as challenges for IT departments.
Enterprises would like to move to cloud computing but are hesitant because they are concerned about providers’ ability to secure company data. Here are some tips that help to ensure that if breaches occur, the business is not left holding the bag.
Edmunds separates customers into segments based on the info it collects on its site and from partners, and uses that to push out custom content, said Brian Baron, director of business analytics for Edmunds.com, at Predictive Analytics Innovation Summit.
The automotive website uses propensity modeling to target ads and customer registration forms, said Brian Baron, director of business analytics for Edmunds.com, at Predictive Analytics Innovation Summit.
Subsidized handsets, rather than locked handsets, should be the focus of regulators. We're not getting good deals, not fostering innovation, and weakening our power as buyers.
Expert Integrated Systems: Changing the Experience & Economics of IT In this e-book, we take an in-depth look at these expert integrated systems -- what they are, how they work, and how they have the potential to help CIOs achieve dramatic savings while restoring IT's role as business innovator. READ THIS eBOOK
your weekly update of news, analysis, and
opinion from Internet Evolution - FREE! REGISTER HERE
Wanted! Site Moderators Internet Evolution is looking for a handful of readers to help moderate the message boards on our site – as well as engaging in high-IQ conversation with the industry mavens on our thinkerNet blogosphere. The job comes with various perks, bags of kudos, and GIANT bragging rights. Interested?
To save this item to your list of favorite Internet Evolution content so you can find it later in your Profile page, click the "Save It" button next to the item.
Email This
