Health information exchanges (HIEs) could just be one of the best glimpses we have into the future of health data analytics. That may seem like a bold statement given the lack of confidence some healthcare organizations express in current data sharing tools and practices, but there are indications that HIE use is picking up and beginning to positively impact health outcomes.
HIE adoption is growing considerably, albeit driven mostly by a few key states. Successes in those states, however, should serve as a real world model for health information exchanges’ potential, thereby spurring wider use in states that currently lag behind.
Today, let’s take a look at 3 key indicators that show HIEs are reshaping health data analytics — and the American healthcare system.
1. The number of health information transactions continues to grow year over year.
From 2011 to 2013, directed transactions rose by a factor of 3. At the same time, requests to view patient records were up more than fourfold, according to a new report by the independent research firm NORC at the University of Chicago.
Industry insiders believe that that trend will continue in 2016.
"In the world of electronic health information exchange, we're on track for another year of momentous forward movement in increased adoption by providers and greater interoperability between Federal and state agencies with private-sector providers," said Dr. David Kibbe, president and CEO of DirectTrust, an alliance of Direct exchange network participants.
That’s not to say that there aren’t challenges to growth.
Available money and time are significant barriers to continued development and proliferation of HIE networks. Moreover, relationships between electronic health record (EHR) vendors and HIE vendors are wary, at best, and there is some concern that sustainability could be jeopardized if EHR and HIE vendors do not work to bridge divides.
Among the states in which HIE activity growth is most robust, Colorado, Indiana and New York have historically led the way. At New York’s Mount Sinai Medical Center, for example, the AppLab unit recently launched its own data-sharing initiative that will allow physicians to share their own digital health pilot projects’ data, called NODE (for “Network Of Digital health Evidence) Health.
The project’s architect and chief proponent, Dr. Ashish Atreja, asserted that it will help hospitals and health systems avoid unnecessary duplication of work in their digital health development efforts.
"Why do we do everything alone?" Atreja asked doctors at this year’s Health Information and Management Systems Society (HIMSS) conference.
"I was on a panel with Boston Children’s and Kaiser. Six of the seven pilots we were working on were the same technology,” he said. “And our teams are working day in and day out on those pilots. Anything that went on in those other pilots, we don’t have to do it. We can take it to the next step."
Atreja was hopeful that projects like NODE Health will eventually help researchers to speed the publication of valuable research data in peer-reviewed journals. Already, his group is informally sharing data on its own blog, for free. That places pressure on journal editors to stay ahead of the data proliferation curve and to reduce the costs associated with formal publishing.
Such grassroots digital health efforts undoubtedly show a growing tendency for physicians to embrace HIEs as a means of spurring digital development and improving the care delivery model. Look for more to crop up in the next year.
2. EMRs have been nearly universally adopted by this point. It’s time to put them to Meaningful Use.
Now that most American providers are operating with EMR (or EHR) systems in place, the computing infrastructure exists to develop gapless HIEs. That will, of course, take quite a bit of investment and even more lobbying of state governments.
In May, the National Coordinator for Health Information Technology, Dr. Karen DeSalvo, said that increased interoperability and healthcare data sharing are not only now widespread health consumer expectations, but are absolutely allowable under the Health Insurance Portability and Accountability Act (HIPAA), as written.
"As a doctor, a daughter and a policymaker, I know that we need to see actionable, usable, electronic health information available when and where it matters to consumers and [to] all of us who are users of that data," she said at the Office of the National Coordinator’s annual meeting.
But DeSalvo also argued that a stronger business case for health data sharing must be made if the healthcare industry is to see wider HIE participation.
"Our chapter ahead is to bring it all together to make it usable and actionable for everybody that wants it," she said. "This is what I hear loudly and clearly everywhere I go, in every community where I have a listening session or visit a clinic or health center or hospital or scientific environment or public health agency.
It’s going to be largely up to providers to create a plausible business case — one that might, you could conjecture be made as more data is reviewed and published.
To a certain extent, then, the healthcare industry faces a chicken-and-egg scenario: it needs increased sharing of health data sharing to prove the efficacy and efficiency of shared health data, thereby to foster more sharing of health data. That’s exactly why grassroots digital health data sharing projects like Atreja’s will be so important over the next few years.
3. The cost of not developing increased hospital cybersecurity now exceeds the cost of developing it.
Of the barriers to HIE participation commonly cited by health administrators, the cost of developing the cybersecurity measures necessary to ensure privacy law compliance has been one of the greatest challenges to overcome. But no longer. For US healthcare organizations, the cost of not developing better cybersecurity is now greater than the expense of investing in effective security.
In a recent HealthcareITNews op-ed, Mike Milliard argued that the prospect of hacks, data breaches and other cybersecurity mishaps bring with it enormous civil liability and heavy Medicare penalties.
Yet US healthcare providers continue to spend, on average, only 6 percent of their annual IT budgets on cybersecurity, whereas financial institutions spend between 12 and 15 percent on the same.
“Inadequate security also exposes providers to potential additional costs related to disaster recovery, ransom, and expenditures for new hardware or software,” he cautioned. Hospitals and provider organizations can’t afford to sit on their hands and plead poverty, or they face even larger cash crunches should the worst occur.
“A much more responsible – and less costly – approach is to invest in technology and training designed to prevent security breaches,” Nerney proffered.
So, if hospitals heeded that advice, and the federal government has already advised that health data sharing is allowable under HIPAA, the two most formidable barriers to HIE participation and expansion would seem to have been overcome.
HIEs will reshape health data analytics. They’ll enable predictive health analytics, pre-emptive health interventions and better follow-on care. They could be employed to reduce unnecessary cross-system utilization, help to tackle the problems associated with polypharmacy, curb cross-system drug-seeking behaviors — there are any number of practical uses for health data sharing.
That potential will inevitably place pressure on wider HIE adoption and reduced regulation. We should expect more HIE barriers to fall in 2016.