A recent article in HealthAffairs describes a significant decline in the number of both operational HIEs and HIEs in the planning stage from several years earlier. The authors note continuing barriers to broad-based HIE and a shift to vendor-driven exchange which diminishes the effectiveness of community-based networks. In effect, this translates to a shift away from geographic-based/dominated HIEs to product-dominated HIEs. We have already noted (see The Interoperability of Things) the lack of a national strategy on HIE, and ONC’s Nationwide Interoperability Roadmap barely mentions the concept.
Consumers continue to be frustrated with lack of access to their healthcare data, even as wearables and other consumer-targeted devices and services continue to sprout. Recently, ONC launched a Consumer Health Data Aggregator Challenge to spur the development of new applications and partnerships to provide aggregated health data to patients. While the financial “prize” for this effort is meager, recognition by ONC might be the real brass ring. This challenge focuses on the use of FHIR exclusively to support interoperability between systems and present data to consumers. I suspect that applicants will have some trouble meeting the requirements of the challenge effectively, and this is indicative of the broader challenge in supporting this type of data access.
Two new articles written by Dr. Noam Arzt, President of HLN, have been published in the most recent (Fall 2015 – just published now) issue of the HIMSS Journal of Health Information Management:
- The Interoperability of Things is an essay about the state of health data interoperability in the US and it grew largely out Dr. Arzt’s experience working on the ONC Nationwide Interoperability Roadmap.
- Fighting Information Blocking in the Emerging Learning Health System is a feature article offering perspectives on the emerging issue of “information blocking.”
Accurate patient matching continues to be a challenge in healthcare, especially in an HIE environment (see my earlier HIMSS posting). No simple solution appears to be at hand. The issue is also inextricably linked to issues of patient identity which are also difficult to solve at our current level of technology. Several approaches have emerged, however, which do not yet seem to be converging. I would characterize the major approaches as follows:
In September 2015 ONC released a new report based on the activities of the HIE Personal Health Record (PHR) Community of Practice. The information is interesting and relevant to IIS as they contemplate patient/consumer access to their systems.
HLN has also done some work in this area (see bottom of this page).