Dr. Farzad Mostashari, the national health IT coordinator, expects health information exchange to ramp up significantly in 2012 because the necessary elements of interoperability will be in place.

The health information exchange strategy means finally bringing together the standards, identity authentication certificates, governance for rules of the road, and the availability of directories or digital provider phone books.

[Commentary: 3 reasons to let customers define HIE services.]

These will enable providers to exchange information whether through a simple transaction for a referral or sharing a test with another provider or a more complex query for patient data.

More work will need to be done, “but I think we really do have the pieces coming together for a big win on interoperability in exchange in 2012,” he told the Feb. 1 meeting of the advisory Health IT Policy Committee.

Health information exchange will be a critical part of the meaningful use of electronic health records (EHRs) as it moves to stage 2 in order to coordinate care and to share data to demonstrate improved patient outcomes.

Mostashari cited the success of health IT vendor Epic Systems in conducting exchanges. Epic CEO Judy Faulkner, also a policy committee member, said the vendor has already exchanged 800,000 documents from Hawaii to California, the state of Washington to New York, California to Ohio, and is also planning to exchange overseas.

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“We are told all the time that it saves lives,” she said. For example, a patient showed up for the first time as she was about to give birth, and through exchange the provider got her record, which showed that she had had a C-section scar that could burst if they hadn’t see that, Faulkner said.

With the standards and other requirements in place, exchanging with other vendors is “almost equally as simple” as exchanging among Epic customers, she said.

State health information exchanges (HIEs) funded by the Office of the National Coordinator for Health IT, are showing some progress as they begin to bring together multiple exchange networks and models within a state, said Claudia Williams, ONC’s state HIE program director.

The program aims to drive exchange in the state by reducing costs, filling in gaps and assuring a common baseline of trust and interoperability. That means building on existing market activities and focusing on meaningful use. “This is a reality-based approach because resources are important and scarce,” she said.

For example, Delaware offered a time-limited free sign-up period, which attracted 500 providers for its directed exchange services to meet meaningful use requirements to share a care summary when a patient is referred and immunization reporting.

In California, the Cal eConnect HIE Expansion Program funds community based initiatives, such as Redwood MedNet to help provider EHRs connect to labs and share hospital discharge and provider care summaries.

ONC also reported that more than 35 vendors have installed the Direct Project secure messaging protocols in their products, while 40 state HIEs are including Direct services in their plans. Four of the state HIEs have already put it into practice, said Dr. Doug Fridsma, director of ONC’s Office of Standards and Interoperability.

As of January, 22 federal agencies and other large organizations are participating in the Nationwide Health Information Network (NwHIN) Exchange for more comprehensive patient data sharing, he said.

[Commentary: Why RECs and HIEs need each other.]

Some exchanges are preparing for NwHIN production. The Alaska HIE and the Medical University of South Carolina are in conformance testing, while the Quality Health Network has moved forward to interoperability testing. 

Last month, the Health and Human Services Department lifted the restrictions that NwHIN Exchange participants must be a federal contractor or grantee. “This is tremendously important” for keeping the momentum going, Fridsma said.