Hospital-Physician Portals: The Role Of Competition In Driving Clinical Data Exchange

Abstract

Recent policy efforts to encourage the use of health information technology are emphasizing development of communitywide health information exchanges to share clinical data across patient care settings. Interviews in twelve U.S. communities show that most large hospitals have or are developing physician portals to provide admitting physicians with remote access to patient records, but there is little data sharing among unaffiliated organizations. Competition among hospitals for physicians is a key factor driving adoption of these proprietary systems. In contrast, provider and health plan competition and adversarial relationships between providers and plans are viewed as major barriers to communitywide clinical data sharing. [Health Affairs 25, no. 6 (2006): 1629-1636 10.1377/hlthaff.25.6.1629 A c o m p e lli n g a r g u m e n t for speeding the adoption of health information technology (IT) is to provide physicians with timely and complete access to their patients' medical records. The fragmentation of the health care delivery system means that pieces of patients' records are housed at multiple locations, most often on paper. Even when provider organizations have clinical IT systems at a given site of care, the systems have limited ability to "talk with each other." Moreover, data usually cannot be shared electronically across sites within an organization or among affiliated providers, let alone with unaffiliated providers.While earlier efforts to promote IT focused on adoption within "silos" (isolated settings) of care, broader "interconnecting" of clinicians has also become a priority for IT advocates more recently. Some providers have begun connecting electronically with others they work with regularly. In contrast, a small number of communities have made progress in developing the infrastructure to support electronic exchange of clinical data among all providers in the market.The Bush administration is actively leading the development of a national health information network (NHIN) that has at its core an interoperable network of regional health information organizations (RHIOs) that can exchange information across the country. In response, many new multistakeholder organizations have sprung up.1 However, major challenges remain in developing a nationwide web of operational RHIOs. 2 M a r k e t W a t c h H E A LT H A F F A I R S~Vo l u m e 2 5 , N u m b e r 6 1 6 2 9

Systematic Review of Health Information Exchange in Primary Care Practices

“…The Veterans Health Administration and its unified EHR exemplify exchange of information within "closed" systems. 9 "Open" systems are exemplified by community-based HIE initiatives, known as RHIOs, 10 which promote exchange of information among independent entities within a geographic region. 11 Open systems face much larger barriers to HIE than do closed systems, including more complicated technical and administrative issues across different technology vendors and organizations, and less clear incentives for stakeholders to share data.…”

“…11 Open systems face much larger barriers to HIE than do closed systems, including more complicated technical and administrative issues across different technology vendors and organizations, and less clear incentives for stakeholders to share data. 9,10,12,13 The Organizational Characteristics of Successful HIE Initiatives For successful HIE implementation, a compelling vision needs to be balanced by reasonable expectations and the ability to deliver a demonstrable benefit to providers. Descriptive studies favor an incremental Figure 1.…”

“…For example, the ambitious vision to build a communitywide, interoperable HIE from the ground up was shown to be insupportable in Santa Barbara, California. 9,10,16,37,43 By contrast, an incremental building philosophy that capitalized on existing infrastructure and data-sharing efforts showed early promise in Tennessee. 2 Examples of achievable early successes include access to test results and clinical notes.…”

“…16 -20 The long-term success of an HIE initiative depends on its ability to provide services within a sustainable business model (possibly involving membership or user fees). 9,10,21,22 For both early adoption and sustainability, a critical mass of data elements and providers along with a preponderance of benefits over barriers may be required to make participation worthwhile for small practices. 21,23 Our systematic review identified themes and examples of benefits and barriers to participation in HIE by primary care practices, which are outlined in Table 2.…”

“…HIE has been reported to improve access to test results and other data from outside the practice, to improve referral processes and claims processing, and to decrease staff time required for handling these processes. 9,10,33,[42][43][44] Rapid electronic access to test results from outside the practice is a valued benefit of HIEs. 10,33,[42][43][44] In the 2008 eHealth Initiative survey, 16 of 42 HIEs (38%) reported improved access to test results.…”