State health data sharing limited by access to broadband, staff and funds
While some states have made strides advancing their health information exchanges, obstacles remain, especially for small and rural providers, according to the Government Accountability Office.
In recent years, public health agencies have been updating their legacy IT systems to enable health information exchanges (HIE) to expedite data sharing among providers and health care organizations.
These efforts were in part supported by the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, which provided $35 billion to support the expansion of health IT across the nation. Of that total, $2.4 billion targeted efforts to advance HIE capabilities.
“Electronic health information exchange can help ensure health care providers have the tools and clinical information they need to deliver more effective care, reduce medication errors and duplicative testing, and improve public health reporting and monitoring,” Government Accountability Office officials said in a recent report assessing states’ use of HITECH funds.
Fifty-one states, territories and the District of Columbia leveraged HITECH funding to support HIE efforts in some way, such as the development of infrastructure and secure messaging, according to the Centers for Medicare and Medicaid Services. But in 2021, HITECH funding sunsetted, and GAO’s report found that while states have made strides toward HIE advancement, obstacles remain, especially for small and rural providers.
GAO reviewed seven states—Colorado, Georgia, Maryland, Minnesota, Missouri, Oklahoma and Washington—that accessed HITECH funding, five of which used all or some of their funding to pay providers “to carry out [HIE] activities, such as connecting providers to HIE organizations or establishing exchange for public health efforts,” the report stated. For instance, Maryland leveraged HITECH funding to develop a public health reporting system, a clinical query portal and a notification service that alerts physicians when a patient has been hospitalized.
Colorado designated funds to develop data and technology interoperability among HIE organizations within the state as well as to connect providers with public health registries. HITECH funding also supported the development of the Office of eHealth Innovation, which is responsible for establishing health IT governance for improved care coordination, data access, health care integration and payment reform.
Washington reported that it did not use HITECH funds to pay HIE providers, but the state completed various HIE-related projects such as enabling data exchanges for behavioral health data and the state immunization registry as well as modernizing state health IT systems.
“While the goal of achieving widespread electronic health information exchange has been pursued for years, it has proved challenging to realize,” GAO officials said.
The report found that small-sized and rural providers struggle to modernize their health IT systems, including HIEs. A lack of broadband connectivity and trained staff are main barriers for less populated and more isolated communities, the report stated.
Other obstacles include a lack of interoperability across health IT technologies and insufficient adherence to health data standards, the report stated. State-specific privacy laws also complicate what kind of health information can cross state borders as well.
Public health agencies that lack financial or technological resources to overcome these IT challenges are more likely to rely on mail or fax to exchange patient information, the report stated. For instance, the GAO found that 56.4% of medium or large hospitals often sent health data via a regional, state or local HIE, compared with just 36.7% of small hospitals.
Improving HIE capabilities remains a priority for all states, despite their various stages of achievement. But now without HITECH funding, states have had to pursue other funding solutions. For instance, 29 states have already requested Medicaid Enterprise Systems funds, which provide financial support for state Medicaid agencies to modernize their IT systems, the report stated.
HIE organizations also identified extra costs associated with the need to provide users with additional services such as data analytics or referrals to social services agencies. These cost pressures are forcing HIEs to consider merging with other HIE providers to consolidate technical infrastructure to save money, according to the report.
Health data utility models are another way public health officials can improve their HIE operations, the report stated. These models can help HIE organizations combine, enhance and exchange electronic health data across care and service settings for treatment, care coordination, quality improvement and public health purposes, GAO said.