Data exchange and interoperability

this past week, HHS announced that $386 million had been awarded to 40 states to form health information exchanges (HIE). HIE will be responsible for facilitating the transfer of medical information between providers. HIE's, although state based, may come together to form regional exchanges.

This highlights one of the underpinnings of the Administrations's vision for health care reform as well as one of the greatest (hopefully not fatal) flaw in our current health care system. Health care is fragmented among different hospitals and providers such that common goverance, communication and shared policies do not exist. This generates quality problems and waste.

One answer would be modeled on Kaiser Permanante or the VAH, where all of a patient's providers are under one organization and where all information is shared down to the last detail (do I need to know if my cancer patient had an negative workup for sleep apnea 12 years ago?). On the next level, all or most of a patient's providers might use the same vendor's EHR product, even if they are independent practices and hospitals. The barriers to interoperablity here are the need for a legal agreement to exchange data access and differing implementation configurations. Epic has piloted an initiative where two different providers could agree to share data on common patients with Epic providing the data exchange through a standardized version of Epic built for this purpose.

However, it is more reasonable to assume that patients will continue to receive their care through multiple providers who use different EHR systems, different versions of the same system and different implementation schemas. Hence the drive to create the regional health information exchanges. However, the data that can be transmitted this way will have to be a limited subset given the different underlying systems. I believe that ASCO's work of defining cancer specific data sets (of which the Treatment Plan and Summary documents are the first step) will be critical to this aspect of heatlh care reform.