This month the Office of the National Coordinator for Health Information Technology (ONC) released a statement outlining its ten-year vision for achieving an interoperable health information technology infrastructure for the nation.  In summary, the vision is for "an interoperable health information technology (HIT) ecosystem that makes the right data available to the right people at the right time across products and organizations in a way that can be relied upon and meaningfully used by recipients."    

ONC acknowledges that today many providers and organizations still restrict information exchange for a variety of reasons:

"Despite significant progress in establishing standards and services to support health information exchange and interoperability, it is not the norm that electronic health information is shared beyond groups of health care providers who subscribe to specific services or organizations. This frequently means that patients' electronic health information is not shared across organizational, vendor and geographic boundaries."

The ONC vision also demands networked modes of information exchange. "This means focusing on query-based health information exchange, or the ability to appropriately search for and retrieve health information, in addition to point-to-point information sharing."

If your organization is participating in WISHIN Pulse you are already on the path to achieving ONC's vision for query-based exchange and are well on your way to breaking down the organizational and vendor boundaries that serve as barriers to the HIT ecosystem.   WISHIN Pulse, WISHIN's community health record product, allows patients' critical health information to follow them wherever they seek care.  Pulse receives health information from participating providers in real time.  If Pulse receives records from multiple providers about the same patient, the records are linked in the system.  When providers treat patients, they can then query Pulse using only a patient name and are presented with an aggregated summary view of all records that have been shared with Pulse (see a video demonstration of WISHIN Pulse).   

In less than two years, WISHIN Pulse has seen substantial adoption statewide.  This is no surprise since Wisconsin has often been held up as leader when it comes to health care innovation.  Many Wisconsin providers have embraced HIT - including health information exchange.  There are currently more than 740 sites of care (hospitals, clinics, nursing homes, etc.) in Wisconsin that are either actively sharing health information or are in the process of connecting to WISHIN Pulse (see a full list of Pulse participants). 

WISHIN Pulse is a strong base from which to build - especially for Wisconsin - but provider and organizational adoption of HIE is still an issue.   Reluctance to adopt HIE stems from multiple drivers.  For some providers the need to exchange health information outside their organization isn't a priority. Others believe their electronic medical records (EMR) system inherently provides enough exchange capability.  And still others are struggling to keep up with the rapid changes in technology and standards required to exchange meaningfully.

Technical barriers to adoption are also a factor, with interoperability - the ability to both exchange the information and use the information that is exchanged - at the center. 

To accelerate adoption of HIE and overcome the barriers for adoption, the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) partnered with ONC in August 2013 to declare that policy levers would be placed, along with incentives and payment adjustments, to ensure widespread adoption of HIE.  These policy levers, along with several other strategies for accelerating health information exchange, were published in Principles and Strategy for Accelerating Health Information Exchange (HIE).  

Some key strategies included are:

• HHS will seek to ensure that all new regulations and guidance on existing programs enable a patient's health information to follow them wherever they access care to support patient-centered care delivery
• HHS will implement policies that encourage HIE incrementally and could evolve from incentive and reward structures to ultimately considering HIE a standard business practice for providers.
• Where feasible, we plan to leverage available authorities to go beyond HITECH implementation to accelerate interoperability and electronic exchange of health information across the health care system.
• HHS' approach to accelerating HIE among health care providers is expected generally to follow a natural lifecycle of incentives followed by payment adjustments and finally through conditions of participation in Medicare and Medicaid programs as HIE becomes an established enabler of patient-centered care delivery.

Together with ONC's ten-year vision statement, the message is clear:  Health information exchange will expand and will become standard business practice for health care.

WISHIN offers a way to remain on the critical path planned by HHS, CMS and ONC, and WISHIN's products are available to providers regardless of business affiliation, health care organization, EMR vendor, or location within Wisconsin.  If your organization isn't already participating in WISHIN, contact WISHIN today (wishin@wishin.org).