In the January 2007 issue of the Journal of Healthcare Information Management, we argued that the American health care system is “a dark, lumpy archipelago composed of tens of thousands of isolated corporate islands that, at least in terms of information, chop up patients into cloistered parcels and then zealously leverage the resulting fragments for economic advantage.” The proposed pathway to link these corporate islands was the deployment of health information exchange organizations that, as quasi-public utilities, could enable the creation of digital feedback loops for any number of stakeholders, including patients.
Since then, the passage of the HITECH Act and the infusion of billions of dollars in subsidies have significantly increased the adoption of electronic medical records, a needed prerequisite to electronic health care information exchange. However, it can be argued the primary benefit of EHR adoption has been to convert analog clinical data into digital data within the same provider organization. While these data are being used to create internal feedback loops on the quality of patient care, the corporate islands remain intact. To an extent, some of these corporate islands have grown to incorporate smaller neighbors and create larger fiefdoms, increasing the number of patients on whom they zealously guard information; but they’ve also widened the barriers between every other corporate island. In other words, the archipelago is still alive and well, and health information exchange between providers, much less care coordination, is barely better today than it was close to a decade ago.
While this assessment might seem bleak—and it is—it is only today’s assessment and does not have to be tomorrow’s. There are several innovative forces at play that will likely shape health information exchange tomorrow if policymakerspayers, and providers show leadership and vision. Two forces have the potential to break through the current institutional impediments preventing a fluid and meaningful exchange of useful health information data: 1) the growing movement of payment innovation; 2) and the emergence of interoperable software architectures that can make data liquid and fungible. We begin with payment reform.