information will be accepted by other organizations and providers, PHRs will risk simply becoming another repository of incomplete isolated information.50Embracing a PHR model of HIE also comes at a cost to society and the overall healthcare system. While individuals may benefit from increased access and control to their personal health information, the PHR may lack a single data repository that could offer additional public health benefits. Without such a repository, HIE has less potential to detect disease outbreaks, identify public health threats, and efficiently report notifiable conditions.53Additionally lost are opportunities for large, population-based research on healthcare intervention effectiveness. A PHR model thus removes additional public goods from an HIE value proposition.Employ Institutional Incentives and RegulationHITECH's ‘connected in a meaningful manner’ requirement has the latitude to allow for minimalHIE participation by providers unless more is specified. History suggests that providers will not necessarily maximize the amount of information exchanged or the number of information exchange partners of their own accord. The Centers for Medicare and Medicaid (CMS), as a federal institution, has the power to rapidly change provider behaviors through two different mechanisms. First, simply as the nation's largest payer, CMS could make participation or membership in an RHIO a requirement for reimbursement. Second, HITECH requires meaningful use of EHR systems, but the legislation did not include any specific measures. CMS, working with the Office of the National Coordinator to create these measures, can set high and specific standards outlining both the type of information exchanged and the expected breadth of information exchanging partners. So far meaningful use only requires that the exchange capability be tested annually. The choice of clinical quality measures that can only be effectively calculated when exchange efforts are present could foster adoption HIE. An example would be measures dealing with patient care coordination.Despite the obvious push for health information technology adoption, current events in the development of meaningful use definitions clearly signal that the true objective of the HITECH legislation is improved quality. In that regard HIE could be considered as a supplement or augmentation of any existing strategies to improve quality and reduce costs like global budget restriction, rate regulation, bundled payments, or even penalties for rapid readmissions. Ostensibly, the existence of information on the care a provider's patients receive at other locations can support the effectiveness of these types of approaches. However, the primary adverse effects of effectively mandating HIE participation would be pushback resulting from the failure of government agencies, other payers, or professional organizational organizations to clearly present a business case for how the HIE can benefit the individual providers in doing their job and maintaining revenues in a time of significant change.
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- Summer '14