Delaware Health Information Network

Does Stage 2 Meaningful Use show lack of support for HIEs?

Kyle Murphy, PhDMarch 11, 2013

At the same time that eligible professionals and hospitals have continued to pursue the meaningful use of certified EHR technology as part of the EHR Incentive Programs, numerous organizations (regional, statewide, and national) have worked to develop infrastructure capable of supporting health information exchange (HIE) and public health reporting.

As part of Stage 2 Meaningful Use, the Centers for Medicare & Medicaid Services (CMS) and Office of the National Coordinator for Health Information Technology (ONC) have taken aim at increasing the exchange of health information among healthcare organizations and providers. But according to one attendee of the ONC Town Hall during HIMSS13, some HIEs (i.e., the noun) are concerned that they will be negatively affected by misinterpretation and confusion surrounding the HIE requirements of Stage 2 Meaningful Use.

During the Q&A portion of the ONC Town Hall, Dr. Jan Lee, Executive Director of the Delaware Health Information Network, asked two questions of the panel that included the National Coordinator Farzad Mostashari, the second of which raised the concerns of HIEs heading into the next phase of meaningful use:

We need to create a really tight marketing message in Delaware to explain to Delaware providers how they can leverage the HIE that they already rely on to meet this requirement, and I have not been able to find anything that says when the provider is ready to attest that they have met this requirement. How will they indicate that they used the HIE? What’s I’m afraid of is that there’s going to be a lot of misinterpretation that is going to drive people away from the state HIE because it’s not clear to them how they account for that when they attest. I’ve been badgering our program officer about this in our biweekly calls until she doesn’t even want to talk to me anymore, but I haven’t gotten an answer yet. So I’m not giving up the microphone until I get the answer.

(For the record, Dr. Lee’s question was followed by laughter and applause from the audience.)

What Executive Director of DHIN brought to the attention of the panel and attendees were the three methods by which eligible providers could meet the transitions of care (ToC) and summary of care requirements for Stage 2 Meaningful Use via:

  1. CEHRT using Direct protocol
  2. CEHRT using SOAP-based/query standards, or
  3. non-CEHRT by engaging a partner (i.e., an HIE) of the Healtheway, formerly the Nationwide Health Information Network (NwHIN).

As Mostashari noted in response, no method was currently in place for aspiring meaningful users to show that they had achieved this requirement using an HIE. “It’s probably under development, and it’s helpful for us to hear that as one of the business requirements for this should be that it is as easy as possible to communicate to the providers attesting that this is an acceptable option instead of leaving it vague,” said the National Coordinator.

According to Dr. Lee, the push and support for EHR interoperability by the ONC and CMS has subsequently worked against ToC option 3 and HIEs in general. “I’ve spoken with some of my counterparts in other states who are feeling the same frustration that we feel like there’s a subtle devaluing of the HIE in encouraging interoperability standards among the EHR vendors,” explained Dr. Lee. “That the HIE organizations are really being devalued and the role that we play in aggregating data on behalf of an entire community, we frankly see that it’s at risk.”

The work of the HIEs and policies established by CMS and ONC are seemingly at odds. However, the National Coordinator made clear that the concern on the part of the HIEs is one of many increasingly challenging those tasked with charting a wide and flexible path toward the meaningful use of CEHRT going forward:

There’s a broader issue, which is we could not in meaningful use say, ‘You must use health information exchange organization.’ We didn’t do that, and I know that there are many on the HIE side who wish we had. What we said was there are going to be many ways in which information gets exchanged — it should be a verb, not a noun — and it’s all good. It has to be good. We have too complex a system and we have to have vendor-to-vendor transmission.

For those organizations relying on ONC funding needing to move toward sustainable operations and business models, the perceived lack of support for these exchanges in Stage 2 Meaningful Use represents yet another obstacle in the way of HIE sustainability. With less than seven months to go before eligible hospitals begin the next phase of meaningful use, clarification cannot come fast enough for HIEs.


“DHIN makes it very easy for us when a patient calls and says that they’ve had lab work or they’ve had imaging done, that we’re able to print that out and have that in their chart and reviewed prior to their appointment. So, it helps us out a lot in terms of time and convenience.”

Wendy Silicato, First State Gastroenterology Association

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