HIEs Still Struggling Financially

While most HIE efforts have enabled participants to meet the core Stage 1 meaningful use criteria for exchanging clinical information electronically, HIEs still face myriad challenges, according to a new report by the Robert Wood Johnson Foundation. The study, titled, “Health Information Technology in the United States: Better Information Systems for Better Care, 2013,” includes five chapters of research focused on HIT issues, including HIE progress and challenges, adoption of EHR, mitigating disparities of EHR adoption, international comparisons of HIT and improving patient education with EHR.

Despite nearly $600 million in HITECH funding that was distributed to help create and expand HIEs--as well as other money received from private grants and contracts--a number of barriers to robust, sustainable financial models still exist, according to the report.

“The majority of HIE efforts report struggling to find a sustainable business model because few providers are willing to pay for HIE and other stakeholders believed to benefit from HIE, such as payers, have yet to offer substantial financial support to these efforts,” the authors concluded. “Tackling financial barriers to HIE is a particularly critical issue facing states as they work to expand HIE and determine how to sustain it when the CAP funding comes to an end in 2014.”

While 74% of HIEs surveyed indicated that developing a sustainable business model was a moderate or substantial barrier, they also reported other challenges to successful HIE. Some of these include technical issues, legal challenges, regulatory barriers, and privacy and security issues.

Further, the survey also found that HIEs face challenges to finding a standard method of exchanging data. While most HIEs reported using a query model as their technical approach, others used a push model where data is actively sent out to users, end-to-end integration, where the data is housed in the user’s electronic system, and direct, which facilitates point-to-point transport of the data.

However, HIEs also have achieved some successes, the report indicates. For example, a 2010 survey found that there were only 75 operational HIEs in existence then, compared to the 119 researchers found for this year’s report. Of those 119, 65% reported exchanging data for less than two years and 24% for three to four years.

Hospitals and ambulatory practices were the most common participants in HIE efforts, with 30% of hospitals and 10% of ambulatory practices participating, according to the survey. Additionally, 82% of HIEs reported exchanging test results, 79% exchanged patient summary care records and 30% exchanged public health reports.