Health Information Exchanges Grow, But Slowly

6 HIE Vendors: How They Measure Up

A new study in Health Affairs reports that 30% of hospitals and 10% of ambulatory practices now belong to health information exchanges that transmit data across organizational boundaries. That's a big increase from 2010, when just 14% of responding hospitals and 3% of physician practices participated in HIEs, according to an earlier poll by the same researchers. But 74% of the 119 operational HIEs in the new survey -- up from 75 in 2010 -- said they were still struggling to find a sustainable business model.

A total of 1,398 hospitals and 23,341 ambulatory practices were participating in the 119 HIEs. The most common types of data that the HIE initiatives exchanged were lab results (82%) and summary of care records (79%). In in-patient settings, discharge summaries were the most common kind of data exchanged. In ambulatory settings, clinical summaries were most often exchanged.

Nearly all of the HIEs enabled providers to demonstrate they had the capability to exchange clinical information electronically. But only 10% of the initiatives could meet all six Meaningful Use stage 1 criteria for health information exchange. Nearly four-fifths of the HIEs enabled participants to provide a summary care record for patients in transitions of care, but less than one-third of them could do syndrome surveillance reporting or send reportable lab results to public health agencies.

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Julia Adler-Milstein, lead author on the paper and an assistant professor at the University of Michigan, told InformationWeek Healthcare, "[The researchers] saw a big increase in the number of HIEs that can support some kind of CCD [Continuity of Care Document] exchange. That was a direct result of a core requirement of Meaningful Use. They didn't support the public exchange reporting, which was a menu option. They have to stick closely to what providers demand and are willing to pay for."

What providers are willing to pay for is still fairly narrow, she added. There's not an appetite yet for broad healthcare exchanges, partly because health plans are not bearing a large share of the cost yet are getting most of the cost benefits of HIE. The study shows that payers participated in less than half of the HIEs and contributed financially to even fewer of them. The authors concluded that one method to improve HIEs' financial situation is to engage payers more fully in them.

The study also indicates that providers are still not supporting the HIEs sufficiently to make them financially sustainable. In some states, like Michigan and Indiana, Adler-Milstein pointed out, this reflects the competition among overlapping HIEs. Other states, like New York, have drawn more solid boundaries between HIE service areas, she noted.

What this leaves is government grants, on which the majority of the HIE efforts still depend. That includes more than $500 million that the Office of the National Coordinator of Health IT (ONC) dispensed to the states to build statewide HIEs or to support local efforts. When that money dries up, the study warns, there's a real danger that the HIEs' viability will be threatened.

Meanwhile, private HIEs have been blooming across the country in recent years, and some of them may have crowded out public HIEs, Adler-Milstein said. Because some private HIEs encompass providers outside their sponsoring enterprises, she added, it's possible that more than 30% of hospitals and 10% of practices belong to HIEs that can communicate across business boundaries.

In any case, she noted, it's likely that the development of accountable care organizations (ACOs) and other value-based payment arrangements will improve the business climate for HIEs, which could stitch together the participants in these new arrangements. Not surprisingly, 87% of the ACOs studied in the Health Affairs paper say that they're planning to get involved in these kinds of initiatives.

"Meaningful Use helps generate some demand for HIE," Adler-Milstein said. "But we feel that the prime business model will come from providing the analytics and infrastructure for some of these other reform efforts."

While HIEs still have a long way to go in this respect, she observed, the survey results show that some are making progress. A third of respondents said they were providing a technical infrastructure to healthcare organizations; a quarter said they were supplying analytic tools; and a third said they were consulting on the design of or operational approach to the new care delivery models.