The One Thing We Do Know About HIEs

Dec. 10, 2014
In an era when results are demanded quickly, many have deemed HIEs a failure. But as a recent RAND study confirms, it’s too early to make any definitive claims.

Last week, when I was reading a study from the Santa Monica, Calif.-based research organization RAND Corporation on health information exchanges (HIEs), I started to think about a personal situation of mine. Without getting into too much private detail, I was thinking about my girlfriend, who is Zambian by birth, but of Indian descent. She came to America about three years ago to pursue a career in Theater Arts (she wants to be an actress, and her ability to cry on cue is pretty amazing). Since then, she has gotten a degree in Theater Arts, but has had trouble finding full-time employment.

Back in Zambia, her father, who wasn’t in love with the idea of her coming to the U.S. to begin with, is anxiously waiting for her to start her career and wondering why it hasn’t happened yet. The reality of the situation is that it’s hard to find a job anywhere, let alone a tough field like this one. I don’t blame her father—he has other children in Australia and India, and has invested a ton of money into all of their lives and educations. Like anyone else would, he wants results.

The fact of the matter is that we live in an outcomes-driven world where everyone demands answers and results right away. Most people don’t even allow for a grace period; the need for results is often immediate. And now more than ever, in an age when breaking news is released in 140 characters, that desire for answers has become even more prevalent.

When it comes to HIEs, there apparently is no time for patience, either. The RAND study more or less found that a lack of evaluation of the more than 100 health information exchanges across the U.S. has made it difficult to determine the benefits of HIE. The study, which was published in the Dec. 2 edition of the Annals of Internal Medicine, found that the relatively few exchanges that have been examined show some evidence of reducing emergency department costs and usage, but other outcomes are unknown. RAND researchers evaluated the health information exchange literature to investigate the effect of the organizations on health outcomes, cost measures, and patient and provider attitudes toward health information exchanges.

The researchers found no evidence showing whether or not health information exchanges are on track as a potential solution to the problem of fragmented healthcare. “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,” Robert Rudin, lead author of the study and an associate policy researcher at RAND, said in a news release statement. “And without an evaluation, it is difficult to draw conclusions… We really don't know what works and what doesn't when it comes to implementing health information exchanges. 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.” More information is needed so that future investments can be spent the best way possible to improve the electronic flow of clinical information, Rubin said. What’s more, a Forbes piece on the same study carried the headline, “Despite $600 Million From Stimulus, Jury Out On Health Information Exchanges.”

Difficult to draw conclusions. Jury out. We really don’t know what works. More information is needed. These are the main words that I take away from the findings of this study. Yes, the federal government has provided nearly $600 million to support statewide HIE organizations. At the end of the day though, we just don’t know the benefit of them yet, or if there ever will be real tangible benefits. Simply put, it’s too early. Patience is needed.

We do know that some HIEs have failed. We also know that some are doing well. In New York, for example, the Statewide Health Information Network of New York (the SHIN-NY) announced earlier this year that it has connected 72 percent of New York State hospitals to the HIE, and the state has allocated $55 million to expand and build it out further. HealthBridge in Ohio and HealthInfoNet in Maine are other examples of HIE successes.

For the April/May issue of HCI, I wrote a feature story on the state of HIEs across the country. Amongst the people I talked to who were involved in HIE organizations in some capacity, there was a debate on if health information exchange should be considered successful or not at the time. To this end, Sumit Nagpal, CEO of Alere Accountable Care Solutions (ACS), a Waltham, Mass.-based vendor with an HIE solution, said to me, “There are still only a handful of success stories (in the tens, not the hundreds or thousands), simply because it’s an early adopter market.” Nagpal felt that this is a result of vendors still not buying into opening up their silos and making data available for everything that it’s needed for, because they haven’t figured out what they will be giving up by making that happen.

The RAND researchers didn’t seem overly optimistic regarding the future of HIEs, though they were fair in admitting that they don’t know enough yet. But in the results-driven, instant-gratification era that we are now in, I’m not surprised to see people already claim HIE is a failure. Nonetheless, based on the evidence in front of us, we don’t know that to be true.  Honestly, when it comes to the evaluations of HIEs, the one thing we do know is that we really don’t know a whole lot.

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