GAO Report Says Challenges Continue for Information Exchange Initiatives

Last week, I had my annual physical examination. The doctor asked me a myriad of questions about my general health as he updated my electronic health record. I asked him how he liked the system. He told me that ideally, it should work great. If I were traveling and if I had a health emergency in another state, the emergency department doctor would be able to call up my health record and have my medical history at his fingertips.

“But the nurses here spend so much time inputting data—it’s an administrative burden. And we can’t even share this information with the doctor across the street, so I doubt we’d be able to share this information with a doctor who’s located across the country.”

That, in a nutshell, is what a recent Government Accounting Office (GAO) report found when the GAO interviewed providers in Georgia, North Carolina, Minnesota, and Massachusetts who were participating in electronic health exchanges. Providers cited issues related to insufficient standards, concerns about how privacy rules can vary among states, difficulties in matching patients to their records, and costs associated with exchange.

The report said that several providers had difficulty exchanging certain types of health information because of insufficient health data standards. Health and Human Services (HHS)—the agency overseeing health information exchanges—has begun to address insufficiencies in standards in its Medicare and Medicaid Electronic Health Record (EHR) initiatives, such as through the introduction of new 2014 standards for certified EHR technology. However, it is unclear whether its efforts will lead to widespread improvements in electronic health information exchange.

In August 2013, HHS developed and issued a strategy document that described how it expects to advance electronic health information exchange. The strategy identified principles intended to guide future actions to address the key challenges that providers and stakeholders have identified. However, the HHS strategy does not specify any such actions, how any actions should be prioritized, what milestones the actions need to achieve, or when these milestones need to be accomplished.

GAO recommends that HHS develops and prioritizes specific actions that HHS will make consistent with the principles in HHS’s strategy to advance health information exchange, and develop milestones with time frames for the actions to better gauge progress toward advancing exchange, with appropriate adjustments over time. In commenting on the draft report, HHS concurred with these recommendations.