Passage of HITECH and the Affordable Care Act marked the advent of the era of accountable care and its foundational initiative, population health management, which relies heavily on HIT systems to communicate with each other and accurately identify patients as they move across a care continuum.

Now, though, CIOs are seeing the real-world impact of that legislation as their organizations sign risk-bearing contracts and uproot their IT infrastructures to ensure compliance.

So when we asked HIT execs what's on their wish lists for next year, they shot for the stars-i.e., industry interoperability and that even more elusive gift, a national patient identifier.

Common sense would have dictated during construction of HITECH and ACA that a national patient identifier was required to support the legislation's goals.

But Congress prohibits government funding of a national patient identifier due to privacy concerns, and lifting of that prohibition has yet to be seriously considered.

Wishing for interoperability and an NPI is really a single thought, since interoperability can never truly happen without the identifier, says Randy McCleese, vice president and CIO at St. Claire Regional Medical Center in Morehead, Ky., which serves 11 rural counties.

Data exchange standards have helped data exchange, but they are unstandardized standards, he adds.

"You put all these kids in the same sandbox and tell them they have to play by the same rules, but each one interprets the rules differently." McCleese understands the concerns of privacy advocates, but contends that in this era patients expect sharing of their health data.

"They already think we do that," he says. And there is sharing, but not as much as there should be because of the lack of adequate standards and the difficulty in achieving health information exchange.

McCleese sees a growing groundswell of realization that the industry must lobby lawmakers to take another look at the patient identifier.

"As we move further with interoperability, this will be something we have to deal with. Accountable care means going beyond traditional borders."

There's also the issue of Congress starting to take providers to task for not achieving the benefits it expected from federal investments in a national HIT infrastructure. But a national patient identifier would enable the industry-and the nation-to take better advantage of those huge investments made during the past several years, believes Eric Yablonka, CIO at University of Chicago Medical Center.

Click here for the entire HDM December feature story on CIO wish lists.

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