This is a guest post by TechnologyAdvice.com writer Jesse Jacobsen. TechnologyAdvice.com is based in Nashville, TN, and their stated mission is to provide valuable insight to business technology buyers, while creating connections with the products and vendors that best meet those buyers’ needs. Their site is a goldmine of industry-specific intel on current software and IT products and trends … and they have a dedicated healthcare tech content channel!
According to the 2013 HIMSS Analytics Report, 73 percent of respondents indicated they were participating in health information exchange (HIE), with 57 percent only participating in a single HIE. Of the practices in an HIE, 52 percent reported experiencing benefits with better access to patient information, 20 percent experience promoted patient safety, and 12 percent said HIE led to time savings among clinicians. Only 16 percent reported no benefits.
As evidenced above, HIEs can be effective tools for improved practice operations, but that doesn’t mean the system is foolproof. In the same report from HIMSS, the top challenges faced by hospitals included other organizations not sharing enough data (49 percent), lack of necessary staff (44 percent) and resources (40 percent), and privacy concerns (39 percent).
As government mandates continue to push provider use of electronic medical records (EMRs) and HIEs, more practices are beginning to consider if it’s time to participate in a health information exchange. The following will look at some of the current benefits from HIE participation and address some current challenges.
Benefits
Better Patient Information
HIEs provide physicians with easier access to patient information, especially on a state level, such as the recently implemented HIE in Florida. Currently, accessing patient information can be a costly and inefficient process, with too much reliance on faxing and email. Utilizing an information exchange makes gaining patient data a quick process with far fewer expenses.
Reduced Imaging Duplication
By reducing duplication of diagnostic tests, physicians can heavily reduce expenses and increase practice efficiency. According to a study from the University of Michigan, around 20 percent of all scans performed by emergency department clinicians were considered repeats. When hospitals used HIEs, patients were 59 percent less likely to have a redundant CT scan, 44 percent less likely to get an additional ultrasound, and 67 percent less likely to have a repeated chest X-ray. Eliminating such duplication can result in significant cost savings for providers, patients, and payers.
Improved Care and Reduced Errors
Simply put, when doctors have quick and easy access to patient records, they can make informed and effective treatment decisions. Without access to this information, physicians are basing diagnosis and treatment decisions on a narrow view of their patient’s health history. With quick access to a longitudinal view of a patient’s health history, physicians can see current and past prescriptions, previous diagnoses, reactions to medications, and any other pertinent information. This information is essential when prescribing medication to ensure that new prescriptions won’t adversely interact with current medication that patients are taking. Between 26 and 32 percent of total medication errors are caused by administrative errors. These are potentially fatal mistakes that can easily be prevented with proper HIE implementation.
Use in Emergencies
For patients in emergency situations, time is of the essence. Being able to access patient information from HIEs helps clinicians act quickly and responsibly. In 2009, the average time spent being treated in emergency rooms was four hours and seven minutes, an increase of 27 minutes since 2002. Increased treatment time in the ER results in increased wait times, which on average took six hours in 2009. ER doctors can decrease patient interaction and wait times with quick and easy access to patient records from HIEs, including information on allergies, past treatments, pre-existing conditions, and applicable test results.
In addition, emergency departments can use HIEs to reduce expenses and unnecessary admissions. According to a study conducted by Weill Cornell Medical College, the chances of a patient being admitted to the hospital was 30 percent lower when the HIE was used, leading to estimated annual savings of $357,000. Decreasing unnecessary admissions also results in shorter wait times.
Challenges
Security Concerns
A report published by the Bipartisan Policy Center found that 25 percent of clinicians cited privacy and liability concerns as barriers to participating in health information exchanges. The argument behind these security concerns is logically sound; if HIE affiliates have increased ease of access to patient information, who else might have this increased access as well? How can we be sure that sensitive patient and practice information is secure? After all, HIPAA violations are quite expensive.
While this concern is justified, most HIE affiliates recognize this potential shortcoming and have established a wide array of policies to prevent any information leaks. For example, when electronic requests for patient information from a healthcare provider are made from an unknown provider, most HIEs refuse to provide any data. As these platforms for data exchange continue to advance and increase in adoption, more policies and safeguards will be put into place to ensure the security of patient files.
Inconsistent or Insufficient Information
Many healthcare providers who have already integrated HIEs into their practice complain that insufficient patient information and inconsistent filing methods are a huge hindrance to HIE success. Data fragmentation is already an issue for the healthcare system as a whole, costing up to $226 billion per year.
Unfortunately, this is a challenge will take time and continual effort to alleviate. As more hospitals and practices begin sharing data, and as the government groups continue to establish detailed, reasonable standards for patient records, data silos will be broken down.
Insufficient Funds
For many providers, developing HIE networks makes very little sense strictly as a business investment. According to a study from the Robert Wood Johnson Foundation, 74 percent of respondents listed developing a sustainable business model as a moderate or substantial barrier to HIE deployment, in addition to a high level of concern about a lack of funding (66 percent).
To tackle this issue, some practices are joining cloud-based HIEs, which charge monthly fees, alleviating the heavy upfront costs typically incurred by other systems. These pay-as-you-go systems can become more expensive than their counterparts however when used for a long period of time. Additionally, transferring patient information through the cloud presents a potential security concern. But, for cash-strapped practices seeking a means to effectively exchange data, a cloud-based community could be the answer.
Lack of Infrastructure
Similar to lacking proper funding, many healthcare providers list a lack of infrastructure as a major challenge with HIE. A survey from Doctors Helping Doctors Transform Health Care found that 71 percent of respondents listed lack of infrastructure as a primary challenge. Adding infrastructure is not only expensive because the infrastructure itself is pricey, but also because the labor and resources required to outfit new systems are expensive as well.
Again, selecting a cloud-based solution can alleviate many infrastructure shortcomings. Cloud systems require very little on premise infrastructure to gain access, and accordingly require minimal labor investment to setup. While building the proper infrastructure to maintain a normal HIE is recommended, cloud-based options are growing in popularity and accessibility, making it a viable solution for smaller practices and struggling health care providers.
HIEs are far from perfect, but the information and resources they provide can add value to practices everywhere. Unfortunately, many of the improvements that need to happen to HIEs simply require time and commitment from a large volume of healthcare providers. The technology is there, and eventually the commitment and investment from practices will be as well.
I’ve been heard here on the topic of getting a barcode tattooed on my neck to avoid having to fill out another one of those damned forms-on-a-clipboard at a medical provider’s office. I’ve also been heard all over the interwebz (mostly Twitter) on the excrescence that is poly-portalitis syndrome (PPS), caused by the plethora of portals presented by providers under current EHR adoption drive.
Which leads me to the observation that the EHR tech I see – all of it, from 
