More HIE evaluation needed to determine benefits

Just 13 health information exchanges (HIEs) out of an available 100 have been evaluated by examining usage information, according to a new review by the RAND Corporation.

“There are likely other health information exchange organizations in the country that are being used, and some may be having an impact. But, if they exist, they haven't been evaluated,” said Robert Rudin, lead author of the study and an associate policy researcher at RAND, a nonprofit research organization. “And without an evaluation, it is difficult to draw conclusions.”

Researchers evaluated existing HIE literature for effects on health outcomes, cost measures, and patient and provider attitudes toward health exchanges. They were unable to find evidence as to whether or not health information exchanges can help solve the problem of fragmented health care, according to the review.

“We really don't know what works and what doesn't when it comes to implementing health information exchanges,” Rudin said. “The evidence base is small relative to the size of federal and state investments, and relative to expectations that it will help address issues related to fragmentation of care.”

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Of the HIEs that were studied, there is some evidence that they reduced emergency department costs, but the review notes that other outcomes are unknown.

HIEs are supposed to facilitate the sharing of patients’ medical information across a chain of providers and stakeholders, leading to lowered costs and improvements in care. They’re being heavily promoted by the U.S. government, which has provided nearly $600 million to statewide HIEs in the last few years, according to Rand.

But as that initial federal money dries up, some HIEs are charging access fees.  The review of 17 studies relating to sustainability found that just 25% of HIEs consider themselves financially stable.

Those fees have caused pushback in the industry, though. According to the most recent Black Book survey, 86% of payers object to the annual fees charged by HIEs.