Among 38 potential service providers, only five were considered in more than 10 percent of buying decisions, according to a new KLAS report, "Health Information Exchanges: Perception in an Expanding Frontier."

Medicity was considered in 23 percent of HIE buying decisions, followed by Axolotl (22 percent), RelayHealth (16 percent), ICA (11 percent) and Epic (11 percent) -- though at this point Epic is strongly considered only for Epic-to-Epic connections, according to KLAS.

Jason Hess, general manager of clinical research for KLAS and author of the new report, said his organization was trying to separate the pretenders from the real deals. "We're finding there are a lot of vendors just chasing that money trail." Hess says KLAS worked to confirm that vendors' claims of having customers up and running were accurate. "We found there's a lot who have selected vendors, but we specifically wanted to find those who were live exchanging data."

Among the 38 vendors referenced in the study, the following 10 were considered most often: Axolotl, Cerner, dbMotion, Epic, GE, ICA, InterSystems, Medicity, Orion and RelayHealth. "When we say there are 38 vendors that came out, the question is how many are legitimate -you can see how often each is mentioned or considered. There are a few that consistently float to the top," said Hess.

The report examines the HIE software purchases or planned purchases of 95 healthcare providers.

The KLAS report also notes how the structure and management of an HIE dictates, in part, the kind of solution a provider will consider:

Public HIEs -- A public exchange may belong to official state agencies or may be semi-independent with direct and typically temporary government backing. "Public HIEs demand solutions with strong potential scalability and need standards-based technology," the report stated.

Cooperative HIEs -- In this model, otherwise-competitive hospitals work together to form independent HIE organizations, generally with an open invitation to other hospitals, clinics and physician practices. KLAS found, "These HIEs often struggle to establish long-term funding and look for vendor solutions that offer flexible and affordable cost alternatives while best adapting diverse EMR technologies."

Private HIEs -- In some respects, private HIEs are designed to enhance relationships as well as exchange data. Often, a single hospital or IDN creates an HIE hoping to draw in community physicians while protecting or increasing revenues. "Funding is less complicated and these HIEs are more likely to be satisfied with solutions that best work with their existing technology," wrote KLAS.

"When you look at a private model, a hospital-sponsored HIE, you don't have as many challenges. They just say, 'We're going to take the financial hit on starting this kind of an HIE,'" explained Hess.

While everyone agrees that exchanging patient data is a good thing, he notes that the best intentions don't necessarily equal success. "The challenge comes when you start talking about who is going to pay for this, who is going to be in charge of the data, so it's about finding a governance model. One organization may say, 'You may have this particular EMR and ED system, well, we have different products, so how are we going to manage interfaces? Are we going to go with a portal or look for the vendors to push the data right into the EMR?' So there are a lot of discussion that have to happen around how you manage that," says Hess. While it's almost certain that an HIE-related requirement will be part of the final Meaningful Use regulations when they are issued in the next weeks, he added, "just what that they will be remains to be seen."

Anthony Guerra is the founder and editor of healthsystemCIO.com, a site dedicated to serving the strategic information needs of healthcare CIOs. He can be reached at [email protected].