Health Information Exchanges aim to facilitate clinical data sharing among providers, but interoperability has remained the key issue.
HIE refers to both the activity of exchanging patient information electronically and the entities that have been created to do so. According to Deloitte and eHealth Initiative, there were 234 information exchange entities in 2010, and another 21 were launched in 2011. The organizations can vary widely in services, governing structure, revenue model and coverage area.
The New York eHealth Collaborative (NYeC) has been building the HIE infrastructure for New York, implementing electronic health records (EHRs) across the state and connecting the EHR systems together for the purpose of sharing data.
The acceleration in desire for interoperability is a driving force behind an interoperability workgroup, founded by NYeC, which recently issued technical specifications to standardize connections between healthcare providers, HIEs, and other data-sharing partners. Whitlinger says the standards are open and available to anyone online.
"This group of states and vendors, which represents about a third of the country, applied engineering resources to some of the paramount problems that the industry couldn't solve as individual vendors, and that the federal government couldn't move fast enough to solve in the time frame needed for implementation," says Whitlinger.
This market shift is being driven by healthcare reform, with Medicare and the private market moving to accountable care models.
"The payment system is starting to reward physicians who work together, and to do that, they need to share clinical data," says Whitlinger. "The demand for record exchange exists where it did not before, because the workflow of physicians didn't dictate it, as they weren't being paid to collaborate."
That was then. This is now.
Commercial plans, through accountable care organizations, as well as states that are implementing Medicaid delivery systems, are shifting to coordinated care models for their high-utilization patients. And to coordinate care effectively, providers need comprehensive data.
Harry Rhodes, director of pratice leadership at American Health Information Management Assn. (AHIMA), says that some HIEs have failed because they resembled some unsuccesful data hubs of the past and because they were unable to prove their benefit.
Another concern of HIE entities is financial sustainability. In 2010 and early 2011, the federal government awarded more than $500 million in grants through the Health Information Technology for Economic and Clinical Health (HITECH) Act for states to build HIE infrastructure. This funding stream will dry up in the next two years. Of the 255 HIE entities chartered by state legislation, only about 25 claim to be financially sustainable.