Electronic Health Records

Integration & Interoperability News

Interoperability, finances, participation still plague HIEs

By Jennifer Bresnick

Health information exchanges are still facing a variety of significant problems according to the newest eHealth Initiative survey of nearly 200 state and community HIEs. While HIEs continue to have an opportunity to flourish as data exchange becomes more important to healthcare reform and initiatives like meaningful use, a series of familiar roadblocks, including interoperability, patient engagement, and financial sustainability, continue to put pressure on these entities.

eHealth Initiative has been tracking HIE development since 2004, providing a long-term overview of data exchange in the healthcare industry. While many HIEs have successfully reached higher levels of maturity and financial stability, interoperability remains a significant concern, especially among the 68% of HIEs that have connected to more than 10 different systems and the 20% that have networked with more than twenty-five partners. A lack of plug-and-play vendor products has contributed to these concerns, with many respondents wishing for standardized pricing and more integration solutions from the marketplace.

Despite these obstacles, a number of HIEs reported financial success in 2013, with fifty-two participants indicating that they receive enough revenue from their partners to cover all operating expenses. Revenue has increased overall since 2011, with seventeen organizations jumping over the $1 million revenue mark. “Similar to past years, respondents still expect hospitals will be the most important source of funding in the future, but also expect a greater role for private payers, and a decreased role for state and federal govern­ment,” the report explains. “Despite continued reliance on public funding by some, organizations realize the precariousness of this revenue source and are working to achieve full sustainability by offering valuable services for a fee.”

These services are likely to include analytics capabilities and additional services to support providers as the industry moves through its various reforms. “If you listen to the HIE community right now, there’s a general consensus that analytics is a significant component of sustainability,” Maine HealthInfoNet CEO Dev Culver told HealthITAnalytics in October. “You have to do it. It’ll be a real challenge to many other HIEs that want to create a comparative picture of data. They will struggle. Because the basic building blocks they’re working with are probably not very standardized. Most HIEs did not undertake that as part of their initial design. So that’s a major challenge.”

An additional challenge will be getting patients involved, the eHealth Initiative survey shows. Few HIEs currently offer patients the ability to view their data, and even fewer allow patients to add information to the exchange. Providers can only view patient-reported data in 30 of the 199 participants. Engagement services like appointment making, medication refill requests, and access to educational materials remain minimal, though half of the respondents did indicate future plans to integrate patient access in the future.

The report suggests that a better understanding of the HIE landscape is necessary before passing judgment on the lack of engagement tools, since patients may instead be accessing a patient portal through their primary care provider or local hospital. “While it’s a little disheartening to see such low patient engagement, overall I think we’re in a better place than we were last year,” said Jennifer Covich Bordenick, Chief Executive Officer of eHI. “Awareness around healthcare reform has helped build the business case for data sharing and engaging consumers.”




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