September 2, 2005
Some good news popped up yesterday. Amidst the disaster of Katrina's suffering which has been all consuming and the general gloomy news, a story about progress in health information access surfaced.
Atlantic Information Services' eHealth Business letter (AIS) reports that health information exchanges are making headway. The eHealth Initiative Foundation has just released its 2005 survey on the state of community-based health information exchanges (HIE). The full report can be accessed for free at the Web site of the Foundation for eHealth Initiative.
The good news is that 109 communities have initiatives going and responded to the survey. The better news is that the majority of these community efforts are beginning to exchange electronic health care data. These steps toward sharing health information within communities is a necessary step toward individuals having ubiquitous access to their personal health information.
According to the report, the primary drivers for developing HIEs are provider inefficiency (77%) due to a lack of patient-specific data and the belief (60%) that HIEs will lead to improved efficiency in general resulting in lower overall health care costs. The third most commonly cited motivation for organizing an HIE (44%) is the availability of government grants. Could this be an example of the faux morality of not-for-profitism? Just under half of all funding is coming from government grants; although sustainable funding comes from other sources as well.
The functionality of these systems is fairly limited. The focus so far is on common patient registration and enrollment eligibility and on forming a clinical information repository. It's a start. Major barriers continue to be: funding sources, lack of physician electronic data availability, health plan participation and governance structures.
Quality and safety are the focus of future functionality development. They include a wide range of proposed information services. Many of the respondents report HIPAA-exceeding security and privacy standards. Management of chronic disease is the primary clinical driver for the development of these systems.
This is good news. Government initiatives toward establishing information exchange standards are beginning to show some results. The vision of government serving the function of seeding a national utility that makes it possible for individuals to get their personal health information “on demand” seems a proper role for government.
Many challenges remain. First, the establishment of information exchange standards requires completion and acceptance. Second, this is still an institutionally focused activity. It puts the needs of institutions and professionals in front of those of individuals with health problems. And it continues to place the view of institutional care in front of the needs and desires of individuals in terms of what they may want for their own health. But connectivity and exchange of information in any form are good starts.
Although there is a belief that somehow this will create efficiency in the system that will result in demonstrable relief in the climb of health care costs, one wonders if this is possible with the current approach. And perhaps this is really the wrong focus anyway.
Access to personal health information will result in efficiency only when the system is fully informed. The system will never be fully informed until the financial transaction and the service transaction take place between the same two people. The second requirement is for that information to be ubiquitously available in real-time. Only then will the system be presented with enough information to make the necessary real-time adjustments to result in true efficiency.
