Implementation of an electronic health record (EHR) is a gigantic undertaking for a practice or hospital, both financially and logistically. Properly training staff and physicians to break old habits and utilize the system to a level to qualify for meaningful use is an even bigger task. With meaningful use Stage 2 approaching however, another spectre looms in the distance, the health information exchange (HIE). One of the proposed criteria for Stage 2 is that exchange of data will no longer simply be tested, but actual exchange will be required.

The HIMSS 2012 leadership survey showed that a little under half of respondents (49%) already currently participate in a HIE in their area. Growth of HIEs that have gone live over the past several years has been tremendous, and as of 2012, there are over 250 HIEs in operation. With increasing requirements for information exchange proposed in Stage 2 of meaningful use and likely even more so in Stage 3, HIEs are here to stay and a large potential market for vendors to break into.

The HIE market is highly fragmented and there is no competitor with a majority share currently. The key focus for vendors should be, as with EHRs, usability. Physicians are reluctant to perform additional steps to access or input information beyond what is already required, especially when the HIE operates on a separate portal. Given the myriad of EHRs used by care facilities from an assortment of vendors, this is a difficult issue to solve. Interface building is a costly and labour intensive process. This is likely where further stages of meaningful use will play a key role in developing information exchange, designating specific standards that vendors must use.

However, there is another underlying issue that needs to be taken into consideration. There is a perception among some physicians that they hold ownership of their documentation, that a record and its associated notes are their own property. This concern is particularly significant in a public HIE, where competing healthcare systems will be required to exchange data. A cultural as well as technological reform will need to continue. As one physician at HIMSS 2012 remarked, I used to be vehemently against using a HIE. Why should I help [my competitor] These are my notes. Then one day I realized, these aren't my notes, my records, they are the patient's.

Change and exchange, it's happening.

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