Despite Increased Use, Most HIEs Still Unsustainable

Although use of health information exchanges (HIEs) grew 69% over the past year, 72% of users believe that by 2017 only 10 of the more than 220 existing exchanges will be functioning without further assistance, according to a recent survey by Black Book Rankings. 

The Clearwater, Fla.-based research organization's latest survey, "2014 Black Book State of the Private Enterprise Health Information Exchange Industry & Top HIE Vendors," paints a grim future for HIEs. Black Book polled 1,550 provider organizations and 794 payers using at least one of the 220 public or private operational HIEs in the U.S. during the last half of 2013 for the survey.

While six in 10 of these HIEs still are funded by HITECH money, 95% of payers, 83% of hospitals and 70% of physicians report that most public HIEs are struggling with flawed business models and are failing to offer meaningful connectivity, according to the survey. Payers continued to be more critical of the exchange model, with 94% reporting that they don't see the value proposition in them and 97% maintaining that they are still struggling to exchange health data with them.

Additionally, fewer than 31% of payers surveyed said they participated in HIEs, while 86% rejected having to pay to use the exchanges. However, 99% of providers said payers should offer them some kind of reward for HIE use.

"With the majority of hospitals and medical practices fully functional with EHR, reciprocal data flow with payers has been the tipping point to provide insurers to initiate leadership roles in private HIEs," says Doug Brown, managing partner at Black Book. "Providers are not benefitting financially yet and without proven worth or certain return, the shift to payer investment in private HIEs was inevitable. The stakeholders that benefit the most from connectivity are the ones that will pay to support exchanges."

Though most providers are concerned about the financial viability of HIEs, they aren't giving up on them yet. For example, 33% are considering private HIEs for more standard sharing of patient data, and 98% believe that private, community/regional HIEs are the preferred choice to comprehensively achieve accountable care organization goals. Eighty-two percent, however, of all payers and providers surveyed believe that an operational national public HIE is at least a decade away.