PHILADELPHIA – With the federal stage 2 deadline for the meaningful use of electronic health records looming less than 2 years from now, doctors need to start thinking about interoperability, directed exchange, and health Internet service providers.
The key capability that stage 2 demands is the ability to transfer patient data in a reliably secure, confidential way between physicians, between a physician and patient, or between a physician and a health care system.
Mitchel L. Zoler/IMNG Medical Media
Dr. David C. Kibbe
These secure, Internet-based data transfers will depend on three elements, Dr. David C. Kibbe said at the annual Congress of Delegates of the American Academy of Family Physicians:
• A standardized format and language for recording the data that transcend the different electronic health record (EHR) formats used by different vendors.
• A method to securely move the data between two or more EHR users, a process known as directed exchange.
• A system to verify that the person engaged in a data exchange – for example, Dr. Smith – really is Dr. Smith.
Although the software that allows these secure exchanges is still being tweaked and has generally not yet rolled out to EHR users, the systems will likely become available in the next few months, said Dr. Kibbe, a senior adviser to the American Academy of Family Physicians in Oriental, N.C.
If the systems work the way they should, physicians will not need to sweat the details. Once EHR vendors get the software finalized and providers in place, all physicians will need to do is sign up for service with the EHR vendor, Dr. Kibbe said.
New Kind of Service Provider
A big part will be physicians becoming customers of a health Internet service provider. Those providers will be something like a conventional Internet service provider, except that they’ll be geared to operate with special certification and encryption procedures to guarantee secure data transmission and validate sender and recipient identities. EHR systems and health Internet service providers will need to use a certification process to establish and confirm the identity of each of their physician clients.
"Health Internet service providers didn’t exist 12 months ago; now many exist, and they are eager to have your business," he said.
Physicians who plan to comply with meaningful use stage 2 and don’t hear anything about this from the EHR vendor by mid-2013 should ask their vendor, "When can you provide it?" said Dr. Kibbe, who also is president of DirectTrust, a nonprofit group that facilitates implementation of directed exchange.
"While some vendors are on top of this, others are clueless," he warned.
And be prepared to pay a bit more for the ability to run secure directed exchange, he said. On the upside, having this capability for secure transmission of EHR data should eliminate the need to send patient information by fax, a step that should save most practices time and money, Dr. Kibbe said.
EHRs Penetrate Family Practice
When he spoke about the next phase of EHR meaningful use at the meeting, he addressed an audience that had already bought into the EHR concept.
"It’s been just about a decade since the AAFP’s Future of Family Medicine led a push for electronic health records for its members," and the push worked, said Dr. Kibbe. In 2004, roughly 10% of AAFP members used an EHR. By 2011, the percent had risen to about 60%, and by late 2012, it had grown to about 80% of the AAFP membership, according to results from recent surveys, he said.
"A few years ago, 40 or 50 EHR vendors exhibited at this meeting," Dr. Kibbe noted. "This year, only nine EHR vendors are exhibiting." That’s because they now find few new customers among family physicians.
Dr. Kibbe said that he had no disclosures.