Exchange and Analytics: The Final Frontiers

by Jennifer Covich Bordenick


In the 10 years since the eHealth Initiative was established, we have witnessed unparalleled growth and enthusiasm for health IT solutions. The progress we have made is undeniable.

Over the last decade, the number of health information exchange initiatives grew from a couple dozen to more than 250. We have witnessed three national coordinators for health IT lead the industry in different and significant ways. Most importantly, we have seen a dramatic uptick in electronic health record adoption levels from single digits in 2001 to nearly a quarter of clinicians now using EHRs.

According to CDC, approximately 25% of office-based physicians had access to a "basic" EHR system in 2010. Moreover, patients better understand the need for connectivity, as evidenced by recent surveys. The majority of patients see health information exchange as a necessity, as evidenced by an April Commonwealth Fund survey that found 92% of patient respondents agree it is important for physicians to be able to share data electronically with other physicians.

A confluence of events made all of this possible: money, policy and technology. A huge infusion of federal money -- $27 billion -- for meaningful use helped kick start efforts in the private sector. Public-private sector policy efforts began with the federal advisory body American Health Information Community in 2005; they have continued with the Health IT Policy Committee and Health IT Standards Committee. And, finally, technology and timing have played a key role in our success. With the advent of social media, PDAs and "apps" over the last decade, patients are open to technology now more than ever.   

According to a 2011 Pew Internet and American Life Project/California HealthCare Foundation survey, of the 74% of U.S. residents who use the Internet, 80% have looked online for health information about one of 15 health topics, such as a specific disease or treatment.

The progress we have made to date has been hard fought and expensive and the growing pains have been severe, but the real promise has yet to be realized. If you talk to a cancer patient waiting for information to be sent from a lab, a public health official trying to track the source of an outbreak, a sick patient waiting months and years for a clinical trial to wrap up or any mother toting around paper copies of immunization forms -- you will find many health care users who have yet to see the promise realized. 

It's time for the nation to double down on the health IT bet, redouble our efforts and take it to the next level. Why? Because the next ten years will make or break this industry, the next decade will be even more challenging than the last one.

Expectations are exceedingly high. Everyone, including politicians, is looking for proof that health IT improves care, outcomes and reduces cost, proof that our investment financially and politically was worth it. We have raised expectations for good reason; we know it works. Those of us who work in the industry have seen the results, but we have done a bad job of communicating the successes. More importantly, we have stopped focusing on what we are going to do with the data. We have stopped talking about why it is so important that we have this data.

Getting to the next level requires two things: exchange and analytics.

Health information exchange, that old familiar phrase, is back in the spotlight. It is not good enough to store information in a deluxe EHR. Health information needs to move, it has to be accessible to the specialist, connect to your smartphone app, flow from your home device, transfer to your pharmacy and download into your personal device -- so that you can use the data. Because without "exchange," all of this talk about EHRs is not very useful. Health information needs to move with patients, so patients and doctors can use the data.

Lastly, analytics remains the final frontier we need to conquer. Right now, we have an overwhelming volume of data from a multitude of sources. The culmination of recent efforts will exponentially increase the amount of data. The real promise of health IT was never about the technology, it was always about leveraging the data. We need to safely and securely aggregate, stratify, investigate, test and dish out the data in 10 different ways for clinical researchers, public health and, of course, patient care.

Given the groundwork we established over the last 10 years, public sentiment, new regulations and the investments that have been made, we are on the right track. All of these things will make faster progress possible in the next 10 years. Let's be sure to keep a clear focus on the promise of the data.

Bobby Lee
Well stated. I completely agree and support the direction and rationales stated above. One note of caution is that we should approach the next phase using the actual data about the past “10 years” of doing and trying, especially in the areas of HIE/HIO, in getting to measureable and predictable value creation. We should be much more selective rather than just throwing darts. I don’t mind doubling down when 11 is on the table but doing it with 16 would be just gambling - a foolish one at that.

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