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A Walk-Back, and Setback, for Sustainable HIE

by Ed Park, COO

Here at athenahealth, we’ve always held the view that the exchange of information is a two-way street and that the cost of information exchange should be shouldered by both sides.

This approach is common in many other industries — so common we take it for granted as the norm. For example, in the ATM industry, you don’t pay an ATM fee for in-network ATMs, but you pay a fee for out-of-network ATMs. In the long distance industry, receivers pay for 1-800 long distance calls. Allowing for either side to pay the communications fee has fueled widespread adoption of these basic transactions.

In 2011, as the government began its multi-billion dollar investment in EHRs, we formally asked the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services whether we could apply this same “in-network/out-of-network” model to health care transactions to accelerate the rate of adoption of electronic information exchange. For simplicity, we pegged the cost of a transaction at $1 — far less than most ATM fees. The OIG agreed with our approach and granted a historic, well-reasoned opinion which stated that “the efficient exchange of health information between Health Professionals is a laudable goal.”

This week they changed their mind.

We are disappointed with the OIG’s decision to reverse course and terminate its Advisory Opinion No. 11-18. As every provider and patient knows far too well, care coordination in health care today is a morass of inefficiency and lost opportunity. Clinical information is often not current or complete, and orders and referrals arrive incomplete or get lost in the shuffle. Redundant work saps staff efficiency and drives up costs. Providers are too often left in the dark as to whether their patients get the care they ordered. A study from the New England Journal of Medicine found that in 49% of referrals the receiving physician was given no information and in 55% of referrals the ordering physician got no information back from the receiving physician. This congested, gummed up system fails providers, patients, and health systems.

The OIG’s walk-back closes one promising path forward to a functioning, sustainable economic model for health information exchange. It represents a setback for any patient who has ever been turned away from a doctor’s office because their referral paperwork hasn’t been received, or handed a clipboard to provide information that a practice should already have had. And it’s a setback for one of the few bipartisan objectives of health reform: care coordination.

Disappointed and frustrated as we are with this policy reversal, we’re as committed as ever to our vision of connecting a nationwide network of care. Over the past fifteen years, we have created a strong national network of 50,000 providers and 3,000 receivers (labs, pharmacies, imaging centers, etc.), all sharing data openly and seamlessly to support the care of 40 million patients nationwide. And with our recent addition of Epocrates, more than 300,000 physicians are connecting into, and benefiting from, this network. While the OIG reversal eliminates one clear path to a functional model for health information exchange, we are confident there are other ways to get where we need to go. We will continue to work by every lawful means with innovative officials, providers, and industry colleagues to advance health care toward a fully modern data economy where a sustainable and fair economic model enables data to flow freely to improve outcomes and lower costs.

Who’s in?

Ed Park is the Chief Operating Officer at athenahealth. 

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