I recently viewed the movie No Matter Where (@NMW_Movie) that was conceived and produced by Dr. Kevin Johnson who is Professor and Chair of Biomedical Informatics at Venderbilt. It focuses on the history of health information exchanges across the country such as the one in Indianapolis. These organizations enable the sharing of clinical information across providers. Integrating the Healthcare Enterprise (IHE) is a national non-profit organization that supports the goal of exchanging healthcare information.
I have posted a number of notes about health information exchanges in this blog over many years starting with the early ventures such as community health exchanges (CHINs) and regional health information organizations (RHIOs) (see: The Winona Project: Is This a RHIO Success Story?; A Quick Look at CalRHIO). Here is a link to a note about Epic's CareEverywhere: Sharing Medical Records across Hospitals with Epic's Care Everywhere. Kevin's strenuous efforts to create the film over the course of five years has been quite remarkable. It makes a very strong case for sharing medical information across cities, regions, and states. During natural disasters like Katrina, hospital paper records were destroyed and patients' lives were put in jeopardy. From the perspective of physicians, easy access to patient clinical data across multiple providers is also essential.
No Matter Where presents an unflinching narrative about the multiple and repetitive failures of health information exchanges over the years. It also provides the reasons for these failures despite clear evidence that they are essential. The stated reasons include inadequate business models, IT technical challenges, lack of common patient identifiers, and the difficulty of translating medical terms into a standardized nomenclature. Kevin and the movie did not gloss over one of the major problems facing information exchanges -- the lack of enthusiasm for the concept by hospital executives and EHR vendors. In our competitive hospital environment, hospital executives often view patient information as proprietary to them. EHR vendors like Epic with their Care Everywhere product make clinical data exchange easy mainly for their client base rather than pursuing it as a broad quality and efficiency initiative for all patients.
One of the questions addressed in a panel discussion on the day following the movie screening was whether it's possible to develop incentives such that more support is generated in the healthcare industry for data exchange. It was suggested that health plans should theoretically support information exchange because it results in cost savings through the elimination of unnecessary services. I personally don't think that we can look to health plans for leadership in this area. Many are not very IT savvy. I also think that it's up to the provider organizations that control the clinical data to take the lead.
The key to gaining momentum for information exchanges nationally is the support of hospital executives. I also think they will never wholeheartedly support clinical data exchange that threaten their bottom lines and also encourages mobility of data and hospital-shopping by patients. What we need is some sort of compromise that promises the exchange of key clinical data elements but will not threaten hospital executives. Tim Pletcher, Executive Director, of Michigan Health Information Network (MiHIN), suggested that some health information networks could focus on "use cases" by which he meant the exchange of key nuggets of information that clinicians find the most useful. I wonder whether hospital executives could be corralled into greater support for health information exchanges if the organizations focused mainly on such "use cases."