Table 5.

Forecasts and recommendations

Environment	Forecasts	Recommendation (to improve transition of care)
United States: HIEs	• Changes in administration funding priorities that reduce government support for HIEs could seriously threaten the move to HIEs.	• Provide interim funding for successful HIEs (in terms of volume of use) while making clear the timelines for a shift to private financing.
	• There will be a “shake out” as some HIEs discover that they do not have a viable business model.	• Continue move to incentives for value-based purchasing. This will encourage providers to invest in development and support of solutions that improve information flow at transition of care.
	• Shift to ACOs will tend to accelerate growth of HIEs.
	• Changes in reimbursement rules are likely to continue the move towards vertical integration of providers (hospitals acquiring group practices). Vertical integration will facilitate improved information flow.	• Publish and support standards for coding medical information to facilitate structured vertical data sharing between different providers.
		• Avoid the temptation to seek maximum data sharing that is not focused on providing benefits to ACOs. Seeking a maximal goal of totally free data flow between providers could undercut the financial incentives driving providers to join HIEs and share data.
		• Eliminate incentives to not modify medication upon discharge (avoid perverse effect of medication reconciliation programs).
Israel: information flow at hospital intake/discharge	• The non-Clalit health care providers will piggyback on OFEK, extending the reach of OFEK to the other HMOs, to government funded and other non-Clalit hospitals, and to other rehabilitation centers and extended care facilities.	• Support easier information flow with promotion of standardized vocabulary/guidelines between the various HMOs and hospitals.
	• The vertical integration of the HMOs provides strong ongoing incentive for improving information flow at hospital intake/discharge. We anticipate that information flow will continue to improve, either through improvements to OFEK or through development of new systems.	• Mandate information sharing.
		• Mandate improvements over time, such as alarms for test results received after the date of discharge. Mandated improvements will drive future enhancements to OFEK or other HIE systems.
	• Clalit, by virtue of its ownership of hospitals, completing the medical services supply chain, and by virtue of its size, is likely to remain a dominant force in HIE and may continue to set de facto standards and platforms for information flow.