I’m still trying to dig out from last week’s HIMSS12 show, which was a rousing success from all quarters I spoke with. (The one notable sore point was the layout of the exhibit floors, which had a lot of people fuming, especially those who were stuck in Hall G, an unfinished basement that had me looking for the ping-pong table and keg the first time I went down the stairs.)

The big news was the release of the proposed Stage 2 meaningful use requirements, which finally hit the streets after an entire week of speculation and false sightings. But the overarching theme of the show was data sharing … how health information exchanges were emerging, along with ONC standards, and how data sharing was spreading across the continuum of care. The ancillary topic of readmissions came up more frequently in educational sessions and casual conversations than it ever has in the past, I’m guessing because of looming penalties from Medicare for provider sites that have readmission rates higher than national norms. (Avoiding readmissions is the topic of our March cover story, which will post to our site in a couple days.)

But all roads lead to the real, underlying issue facing large-scale data sharing: the establishment and scalability of trust among health care entities exchanging data. The Nationwide Health Information Network Exchange is an example of both the progress and roadblocks to large-scale data exchange.

The NHIN Exchange, a public-private partnership involving federal agencies and the private sector, can serve up some impressive numbers: 500 hospitals and more than 4,000 providers linked up; 1 million shared patients/beneficiaries covered via the current connectivity; 65 million people in the population coverage area of the participants, which include all-stars like Marshfield Clinic, Kaiser Permanente, the Regenstrief Institute and a host of stellar HIEs such as HealthBridge and the Utah Health Information Network. The Exchange is onboarding a number of HIEs and other stakeholders, such as the Indiana State Department of Health, as well as more HIT vendors.

And yet  …  this effort has been spent years in the kitchen, part of which was spent creating a governance structure and hammering out a data use and reciprocal support agreement (DURSA), along with ways to manage digital certificates, service registries and testing. And this with a group of data exchange pioneers who have advanced capabilities and governance structures. You can’t expect technology and governance structures to appear overnight, but it’s an indication of how far the broader industry has to go before the interoperability the ONC and private sector stakeholders envision can come to life.

At HIMSS12, I met with ONC leaders and listened in on presentations that delved into the Exchange, the Direct Project, the Connect Project, the Nationwide Health Information Network, and the Standards and Interoperability Framework, the latter being a kind of the blanket that’s thrown across all these efforts. And the common theme to all of those conversations was the struggle, technologically and politically, to scale up trust.

DURSAs and other operational components are all well and good, but I have yet to hear of a trusted enforcement mechanism for those agreements. That glaring shortcoming reminds me of the first few years after HIPAA came down from the mountain; there the industry was with new and stringent data security and privacy requirements, violations of which were flooding in on a daily basis. But there was no trusted mechanism to enforce those requirements and punish wrong doers. The lack of oversight led to frustration and disenchantment for many who were trying to play by the rules, and carte blanche for those who decided they didn’t have to much to worry about if they disregarded the regulations.

Mark me, scalability of trust is going to be a long time coming, as is nationwide interoperability, if DURSAs aren’t backed up by unsmiling guys in dark suits, and stakeholders who want to share data aren’t assured that they aren’t throwing clinical and financial caution to the wind when exchanging patient data. And data sharing agreement enforcement policies aren’t fully baked at this critical juncture, when the just-released proposed Stage 2 requirements for the meaningful use program are intent on ramping up data exchange. (Click on our recent Stage 2 slideshow that breaks down those HIE requirements.)

On an aside, if you were flying back to Chicago from Vegas, I feel your pain. Before that mild storm hit, I planned to be at home Thursday night, but didn’t roll in until Saturday afternoon from Milwaukee, where I ended up because all the Chicago flights were full. I spent a bit too much idle time Friday in front of a Wheel of Fortune slot machine, and had to report back to my wife that we can still plan to send the kids to college, but we better get some brochures from community colleges.


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