The federal government has been actively encouraging health information exchange through direct
grants and leadership. However, its challenge now is keeping focused and getting the multiple
By Chris Dimick
THE OFFICE OF the National Coordinator for Health IT is attempting to do in a few years what the private sector has not
achieved in decades—create a wide network of healthcare
providers exchanging patient information through electronic
health records (EHRs).
It is a daunting task, but one that ONC has seen significant
progress on since the American Recovery and Reinvestment Act
of 2009 named EHR adoption and health information exchange
(HIE) a priority. ONC and the Department of Health and Human Services have distributed hundreds of millions of dollars
through targeted programs intended to foster EHR implementation and the advancement of state-level HIEs.
But in the push to spur EHR adoption, some say ONC’s focus
on HIE has waned. While ambitious programs like the Regional
Extension Center program and the meaningful use EHR incentive program give providers technical and financial support for
EHR adoption, similar efforts to develop HIEs have been slower
In December the President’s Council of Advisors on Science
and Technology (PCAST) noted as much, stating in a report that
evaluated ONC’s efforts that more work was needed to foster
health information exchange.
“In analyzing the path forward, we conclude that achievement of the President’s goals requires significantly accelerated
progress toward the robust exchange of health information,” the
report states. If progress in information exchange lags too far
behind EHR adoption, the authors warned, the result could be a
lot of new EHRs that do not connect to each other.
“I get the sense that the federal government was really focused
on the electronic health record and may have taken their eye a
little bit off the HIE initiative, hoping and relying on the EHR and
HIE communities to fill in the gaps when it comes to interoperability,” says Jonah Frohlich, managing director of healthcare
consulting at the law firm Manatt Health Solutions. Frohlich is
the former deputy secretary of health IT at the California Health
and Human Services Agency and has worked extensively on
There are a score of HIE projects under way at the local, state,
and federal levels. But whether the efforts are aligned and heading toward a big leap in the interoperable exchange of health information across the country—ONC’s ultimate goal—is unclear.
The State of HIE
ONC, for its part, believes that they are. However, the office does
acknowledge that much work remains to be done, and it notes
that the “robust exchange of health information” cited in the
PCAST report has inherent challenges that make it tougher to
tackle than EHR adoption.
Four Major HIE Projects
There are four major HIE initiatives currently unfolding nationally.
The Direct Project, developed by ONC, created standards and
specifications for simple information exchange between providers via secure e-mail. The project launched its first pilot sites
in early 2011, with the expectation it will be available for mass
use in 2012. Direct was created by ONC in part to help providers
meet the basic HIE requirements called for in the stage 1 meaningful use EHR incentive program.
The Nationwide Health Information Network (NwHIN) Ex-