Institute for eHealth Policy Briefings - Issues & Opportunities

Open Access to Data will lead to the Goal of “Health” over “Health Care”  - Marc Wine

The Institute for eHealth Policy briefing, held on Capitol Hill June 20th, presented the challenges and barriers to overcome as  rural and underserved communities work to adopt interoperable EHRs. 

Build the Business Case for Connectivity
Feygele Jacobs of the Community Health Foundation moderated the event.   The speakers represented  a cross section of federal leadership and private sector HIE  participants.  They were Yael Harris, PhD Director of the Division of Quality with the Office of Health Promotion and Disease Prevention; Marcia Cheadle, RN Director of Advanced Clinical Applications for Inland Northwest Health Services; and Angie Franks President and CEO of Heartland Health, Inc..

More than seventy-two million Americans live in rural areas, yet many are isolated without adequate connectivity. 

Ms. Jacobs summarized the challenge for achieving interoperability efficiently by pointing out that there is lacking a business case  for connectivity and linkages across provider’s EHRs.  Incentives for adopting interoperable EHRs  for certification under Meaningful Use Stage 1 and Stage 2 need to address critical referral pattern issues and disruptions in clinical work flows.

Promote Consumer Centered Health
Dr. Harris characterized  the scope of the challenge with underserved communities. Eighty to ninety-five percent have EHRs; yet the barrier is many EHRs are stand-alone that do not have interoperability across providers.  Getting from Meaningful Use Stage 1 to Stage 2, (e.g., requiring  patient-clinician data transmission, clinical decision support and electronic syndromic surveillance data exchange) is a huge challenge. 

Having access to EHR data that will show clinicians the disparities among patients in rural communities will be impactful, Dr. Harris said.  The ability to use disparities information will help providers address practicing a population based delivery model by open access to underlying social and demographic  causes of illness.

A huge lack of broadband is another challenge to EHR interoperability.  About eighty-percent of people without broadband live in rural communities.  Dr. Harris mentioned vendor support for rural EHRs has been unreliable. 

Overall Dr. Harris emphasized her view of the biggest barriers to adopting health IT in rural areas are: needs for optimizing  a system going from Meaningful Use Stage 1 to Meaningful Use Stage 2; interoperability for data exchange across provider networks; patient identification and having common capabilities for protecting patient privacy; and accessing information through telemedicine and tele-health  with remote monitoring. 

Among goals for the future of interoperability in rural and underserved communities, Dr. Harris cited providing data exchange across all communities, support for  clinicians for training; promoting use of data in real time for clinical decision support; and coming up with better interactive methods using  mobile Health. 

The ultimate goal for supporting consumers  living better and making knowledgeable choices is to adopt EHRs that are interoperable and promote “health” over “healthcare.”

Move to Open Standards, Population Based Model
Heartland Health is a prominent integrated delivery system providing services in health care in a 21-county area of northwest Missouri, northwest Kansas and southeast Nebraska.  Heartland’s vision for the 21st century includes a patient-centered, fully integrated regional health delivery system inclusive of all payers and providers and is on course to become a benchmark as one of the best health organizations in the nation. 

Angie Franks  the CEO of Heartland summarized her view of challenges  facing rural and underserved communities. Moving to a model of population health management will help physicians asses their entire population across rural and underserved areas.

Through interoperability of EHRs employing population health methods, physicians in rural areas can assess and stratify patients for targeting interventions to the right patients. Achieving full interoperability will deliver a more efficient and effective way to help manage rural and underserved populations because routine, time- and labor-intensive work involving outreach, care coordination, education and quality reporting .  Rural health provider’s adoption of interoperable EHRs are hampered by limited resources to keep up with the pace of health IT change and the fact that rural and underserved populations tend to have more health problems to address.  

Ms. Franks  emphasized two challenges toward achieving EHR interoperability among rural and underserved providers that need to be addressed. One is extending the timeline for Meaningful Use Stage 2. 

The College of Health Information Management Executives (CHIME) has proposed a  one-year extension of Meaningful Use to achieve success. The recommendation was part of a letter that CHIME sent to six U.S. senators who asked for feedback on their report that criticized the direction of the Meaningful Use program.  According CHIME the additional time "will give providers the opportunity to optimize their EHR technology and achieve the benefits of Stage 1 and Stage 2; it will give vendors the time needed to prepare, develop and deliver needed technology to correspond with Stage 3; and it will give policy makers time to assess and evaluate programmatic trends needed to craft thoughtful Stage 3 rules."

Second Ms. Franks called for continuing to focus on standards development for interoperability for supporting the more efficient adoption of EHRs across rural and underserved communities.  It is important for rural communities that we achieve a consensus of interoperability standards among providers for using EHR data, beyond simply exchanging data, in order to avoid driving up costs and complexity. 

HIE as a Community Asset Requires Open Access
Marcia Cheadle, RN oversees the implementation of Meditech’s Advanced Clinical Applications for over 23 facilities across Inland Northwest Health Services including the design of a multidisciplinary program strategy ensuring successful execution and adoption of electronic records in Washington State.  Inland Northwest engages with Beacon programs, VA VLER, SSA and CDC and is helping medical centers prepare for ACOs.

Ms. Cheadle advocated looking at health information exchange as a community asset for making the best decisions for patients. 

The speakers pointed to the challenge that rural Americas are more likely to suffer from chronic illness than their counterparts in urban and suburban areas  rural hospitals.  Compounding the poorer health conditions are capital constraints that hamper rural hospitals’ adoption of health IT that would be a key enabler to improving  the quality , safety and efficiency of health care. 

Therefore, the importance of open and transparent rules governing  health data exchange and collaboration are necessary to ensure that all providers and patients have interoperability for advancing the national quality strategy of three aims: 1) Better Care;  2) Healthy People and Communities; and 3) Affordable Care.  (The Governance Framework for Trusted Electronic Health Information Exchange (the Governance Framework), intended to serve as the Office of the National Coordinator for Health Information Technology’s (ONC’s) guiding principles on HIE governance, was issued in May. See

Ms Cheadle explained that communities need to understand how organizational structure effects the exchange of data within the community.  Specifically she referred to the behavior of large organizations coming into communities and imposing their standards.  By way of preventing closed standards practices that Ms. Cheadle referred to, rural and underserved communities must proactively promote inclusive participation and adequate stakeholder representation, including patients, in the development of HIE s and adoption of interoperable EHRs.

Ms. Cheadle summarized that we moved forward from previous technology  that involved shared information systems with standardized data to disparate information systems relying on health information exchange to conduct business. 

Rural and underserved communities are moving into a more advanced environment characterized  as a population based approach  in a competitive health system where disparate information systems will interact with shared information hubs that support common metrics and care coordination.

Overall, rural and underserved communities will benefit from adopting open access exchange services that will enable partners to decide who they can exchange information with and how exchange could be completed , with assurance of greater vendor reliability. Open access will lead to reaching the ultimate patient-centric goal of achieving health over health care.  The consumer wins control over their own health choices and the provider wins with quality, safety  and efficiency.