AbstractRecent federal policies and actions support the adoption of health information exchange (HIE) inorder to improve healthcare by addressing fragmented personal health information. However, concerted efforts at facilitating HIE have existed for over two decades in this country. The lessons of these experiences include a recurrence of barriers and challenges beyond those associated with technology. Without new strategies, the current support and methods of facilitating HIE may not address these barriers.IntroductionPersonal health information is not utilized to its full potential to support effective and efficient care due to fragmented information creation and storage. Health information systems are typically isolated, within hospitals, physician practices, laboratories, or pharmacies.1Changes in insurance coverage, reliance on multiple providers, and increases in specialty care add more and more potentially relevant, but disparate, information into a fragmented, non-interoperable non-system.Numerous factors in our society underscore the need for changes to this state of isolated, fragmented health information. We are a mobile population requiring access to vital information in different locations. For example, many retired Americans receive treatment in very different locations seasonally, and increasingly prevalent chronic conditions, like diabetes, can only be managed by information-based care management. Many obvious patient safety and quality issuesarise in the handoff of patients among providers that fail to share necessary information. Natural disasters displace individuals to locales with unfamiliar providers and can destroy or render inaccessible existing health information repositories. The growing use of pharmaceuticals and associated recalls of drugs from the market may call for immediate identification of affected individuals. Finally, the likelihood of serious pandemics calls for rapid identification of ill persons and accurate immunization histories.Policy makers, researchers, industry groups, and healthcare professionals identify health information exchange (HIE) as a solution to these problems.2–5HIE is the process of sharing patient-level electronic health information between different organizations6; the potential effects of making previously unavailable patient-level information available to healthcare professionals are widespread and address nearly all of the Institute of Medicine's quality aims. While HIE promises cost and quality improvements, to date we lack substantial and consistent empirical demonstrations of the effectiveness of HIE.7–9Title XIII of the American Recovery & Reinvestment Act of 2009, also as known as the Health Information Technology for Economic & Clinical Health (HITECH) Act, is the most recent example of federal support for HIE.6HITECH requires electronic health records (EHR) be ‘connected in a manner that provides…for the electronic exchange of health information to improve the quality of healthcare’ in order to be eligible for any incentive payments. This builds
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- Summer '14