The fact is, the information needed to treat a patient today exceeds what a physician can handle, says ACS's Bauer. "We are moving toward a genetic and molecular understanding of disease, and there is no doctor smart enough to handle all of the data. They need information support systems to make better decisions," he contends. And those systems need a comprehensive, flexible, and manageable way to handle complex health information.
Tackling the information exchange issues
HL-7 (Health Level 7) certification sets the transmission standards among different systems, such as how to transmit lab information, prescription data, and a diagnosis. So this information exchange component is largely in place.
But privacy issues remain, and they are a more difficult challenge. Most states have added their own requirements to HIPAA's privacy standards. Thus, for the most part, if you are a hospital in one state trying to send patient data to a hospital in another state, it can only be done on a one-to-one basis, typically with a phone call and proper identification.
However, both nonprofits and for-profit organizations have been trying to meet this challenge through the creation of something called RHIOs (regional health information organizations), consortia composed of small hospitals and health plans that work out how to share data among themselves, and often with nearby RHIOs. It's an ad hoc approach that tries to get some of the key EHR exchange benefits in place without waiting for federal or state standards
A dot-com-era provider, Covisint, has entered the RHIO fray. Covinsint was one of the first e-marketplaces created for the auto industry, but it now has a health care arm deploying the same tools for medical practices that it used to let auto industry vendors and suppliers communicate, buy, and sell while keeping information shielded from competitors.
Covisint checks credentials, makes sure all participating organizations are compliant with regulations, and supports more than 200 APIs so that medical providers can connect to the various practice management systems. Covisint has become the statewide backbone for Minnesota's medical providers; it also connects nine RHIOs to each other.
The usual service providers like Accenture, Hewlett-Packard, and IBM have health care practices. But now Microsoft, Google, and AOL founder Steve Case's Revolution Health are looking at entering the health care information exchange market. All three offer individuals a personal health record, which puts the patient in control of his medical information. But the business aspect is in giving health care providers access to a person's complete health record from a single site.
There are two major questions around the reliance on health records from these providers, say industry analysts. One is whether users will trust a for-profit organization to care for the most personal kind of information. The second is whether each of us can be trusted to manage and keep such a life-and-death record up to date or if it's safer to leave that responsibility to organizations whose only job it is to keep the health data updated.