6 Top-Notch E-Prescribing Options

More than 80% of hospitals either participate in or plan to join a health information exchange, according to a recent survey by Capsite, a healthcare technology research and advisory firm. Of the 340 hospital respondents, 32% said they were already involved in an HIE, and 47% said they intended to join an exchange.

These percentages are congruent with the findings of HIMSS' 2011 Leadership Survey, which was released in February. According to that survey, only 31% of the mostly hospital respondents had no plans to participate in an HIE, implying that 69% either were involved or planned to be part of an HIE. Forty-four percent said they already participated, up from 37% a year earlier.

The problem with the Capsite survey results is that the term "health information exchange" isn't well-defined, notes Greg DeBor, a senior consultant with CSC. "Almost everything in the report was classified as HIE," even electronic prescribing, he pointed out. While e-prescribing is part of health information exchange, it isn't usually regarded as an HIE in itself.

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The fuzziness of hospital participation in HIEs, he continues, was underlined in some research that CSC did a year ago for a state that he preferred not to name. "We found almost all the RHIOs [regional health information exchanges] were reporting that almost all the hospitals were participating. But their definition of participation in some cases was that they'd signed a memorandum of understanding."

Nevertheless, there are indications in the Capsite report of growing hospital interest in HIEs. For example, nearly half of the respondents said their chief reason for joining an HIE was to meet the government's criteria for Meaningful Use of an electronic health record so they could qualify for financial incentives. That rings true, since the vast majority of hospitals expect to apply for the incentives.

The Meaningful Use factor also has a bearing on whether the respondents were involved in or planning to form private HIEs or communitywide exchanges. While the Capsite poll didn't delve into that aspect, stage 1 of Meaningful Use requires only that hospitals test their ability to electronically exchange key clinical data with other providers and patient-authorized entities. That could be done within an enterprise.

In stage 2, however, the facilities will have to exchange data with providers that use heterogeneous systems, notes DeBor. So some of the hospitals may be supporting community HIEs to prepare for the stage 2 requirements, he said.

The results of a recent KLAS survey, however, support a contrary argument. While the number of live, enterprise-wide HIEs tripled to 161 this year, KLAS found, operational public HIEs grew much more slowly, from 37 in 2010 to 67 this year.

In fact, there's evidence that the preference of healthcare systems for keeping their information in the family has undermined some community HIEs. CareSpark, a RHIO based in Kingsport, Tenn., went under recently because hospitals found they could form their own exchanges more cheaply than it would cost them to support CareSpark.

As hospitals geared up for Meaningful Use, DeBor observes, interest in HIEs took a back seat to the need for operational changes in many facilities. But in recent months, he said, he's seen an upswing in interest because of the emerging new challenges of Accountable Care Organizations and bundled payments. You wouldn't know that, however, from the Capsite survey, which showed only 2% of respondents were mainly drawn to HIEs because of their value in ACOs.

The preferred HIE vendors of the survey respondents included Medicity, Cerner, Epic, RelayHealth, and eClinicalWorks. Of those firms, only Medicity (owned by Aetna) is not an EHR vendor or corporately related to an EHR vendor. EClinicalWorks sells only ambulatory-care EHRs, although it claims it can also connect hospital systems. DeBor says he's surprised that Axolotl, a major HIE vendor owned by OptumHealth, is not on the list.