The 3 Biggest HIE Challenges

For the past 10 years, eHealth Initiative has monitored the growth of data exchange within the U.S. healthcare industry. This year's annual survey on the state of health information exchange reveals three of the biggest challenges currently facing HIEs.

The results are based on responses from 199 data exchange initiatives, 90 of which are community-based HIEs, 45 are state-designated exchanges and 50 are healthcare delivery organizations.

1. Interoperability. Of the survey's 199 respondents, 68 organizations have the challenging task of connecting to more than 10 different electronic health record systems, and 32 have to connect with more than 25 different systems. Altogether, 151 exchange organizations have had to build multiple interfaces to connect disparate systems, and 142 organizations reported interoperability between health IT systems as a major concern.

Jennifer Covich, CEO of eHealth Initiative, is not surprised interoperability is an issue. "Connecting multiple systems is difficult and expensive," she says. "These results really drive home how hard it is."

To combat these issues, the surveyed organizations expressed a desire to see more standardized pricing and integration solutions from vendors, more technology platforms capable of "plug and play" functionality and more of a consensus among providers for standards for data vocabulary and transport.

2. Financial stability. HIEs have generally become more financially stable over the past two years. As compared with the 2011 survey, six fewer organizations reported revenues less than $1 million, and 17 more reported revenues more than $1 million. In total, 52 organizations reported bringing in enough revenue from participating entities to cover operating expenses.

However, 49 organizations currently receive more than half of their funding from public sources, including the federal government. Of these, 17 expect public funding to continue to constitute the majority of their income. Many realize a reliance on public funding leaves them in a precarious state as the influx of funds following the passage of healthcare reform and the HITECH Act is tapering off, and are working to institute a fee-for-service payment model.

Even under fee-for-service, HIEs will increasingly have to offer more advanced services to an industry moving away from fee-for-service care delivery. Accountable care organizations and similar value-based models demand a higher level of data exchange and analysis, and many HIEs have begun to offer more advanced services. Of surveyed HIEs, 83 plan to offer alerts to providers, 83 plan to offer connectivity to other networks, 78 will give patients access to their information, 74 will offer analytic capabilities and 64 will allow participating entities to exchange medical images.

It will now fall on the HIE to demonstrate the new services are worth increased fees, something that has been historically difficult for these organizations, according to past eHI surveys.

3. Competitive concerns. "Hospitals are currently walking a fine line — it makes sense to let other hospitals have access to patient data to coordinate patient care," says Ms. Covich. "At the same time, hospitals don’t want their competitors using their data to take business away."

This prioritization of competition over exchange among hospitals and ambulatory providers, the main HIE stakeholders, has affected HIE behavior. Of those surveyed, 33 HIEs are restricted to entities within a health delivery network, and 58 HIEs have not connected with any other network, such as a regional HIE, a state-designated network or the federal eHealth Exchange.

Hospitals, and by extension HIEs, will soon have to put their competitive instincts behind them, says Ms. Covich. "It's all about making sure providers have all the information they need on a patient," says Ms. Covich. "Successful organizations find ways to share data with competitors."

Where the survey indicates challenges, however, Ms. Covich sees opportunity. "Patient care is disjointed. Successful health reform requires data exchange and consumers are demanding access to their information," she says. "This is really the perfect storm. The need to connect is more blatant than ever, a perfect opportunity for HIEs to demonstrate their value," as technology and data issues, including HIEs, have the potential to change the healthcare industry for the better.

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