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.
The prognosis for EHRs
EHR providers are, not surprisingly, bullish on the future of EHR efforts. Greg Mancusi-Ungaro, a senior director at Exigen Services, says deploying an EHR system is just like implementing any big enterprise application, only the enterprise in this case is bigger and the stakes are higher. "The technology exists today and despite the fact that we lack some core standards, we are enabling the development of a flexible infrastructure to stay in tune with requirements. I can visualize a successful national system," he says.
As Kaiser's Chin points out, there is a convergence occurring around health care technology regarding how to share it and use it to assist delivery of services and treatment. But the challenge of orchestrating and satisfying so many stakeholders remains. Plus, even if the solutions are mandated rather than eventually negotiated, the task of gathering the many pieces that are still in flux, then integrating them remains a complex technical and process task.
Over time, both industry representatives and analysts expect that every U.S. citizen will have an EHR available nationwide. But to make it happen will require a great deal of cooperation, innovation, and an investment in health-oriented IT. This shift will likely start at a less ambitious level than the political rhetoric suggests, with local practitioners sharing patient information in a local health care ecosystem.
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