HIEs More Economically Viable, But Interoperability Challenges Remain

Nov. 7, 2013
Health information exchanges are becoming more sustainable, but they continue to struggle with the cost and complexity of writing interfaces to multiple EHRs, according to eHealth Initiative’s 2013 Health Data Exchange Survey.

Health information exchanges are becoming more sustainable, but they continue to struggle with the cost and complexity of writing interfaces to multiple EHRs, according to eHealth Initiative’s 2013 Health Data Exchange Survey.

In 2013, eHealth Initiative surveyed 199 organizations, and a large number of them highlighted the challenge and expense in getting dozens of different systems to talk to each other, said Jennifer Covich Bordenick, chief executive officer of eHI. In fact, 68 organizations reported having to build 10 or more interfaces with different systems, and more than 140 cited interoperability as a pressing concern.

“Connecting is hard and expensive,” Bordenick said. “We asked what could be done to overcome interoperability challenges. “Respondents said they are looking for standardized pricing and integration solutions from vendors.”

Bordenick noted that the survey also shows that many HIEs have not yet developed ways to allow patients to enter or view their own data in the health exchanges. Only 31 organizations currently offer patients access to their information. Even simple patient engagement services, such as tools for managing appointments or prescriptions, are rare.

In a panel discussion, Mike Dittemore, executive director of the Lewis and Clark Information Exchange in Kansas City, Mo., said several LACIE members have invested in putting their own portals together and are concerned that a LACIE patient portal would take away from utilization of the portals they have invested in for wellness initiatives. “The issue is around money already invested in organizations’ portals and having them negatively impacted,” he said.

In the last two years, more data exchange initiatives have become financially viable. Many organizations are reporting greater revenues and 52 have received enough revenue from participants to cover operational expenses. Among respondents completing the survey in both 2011 and 2013, only 16 reported they were sustainable in 2011 and 35 reported they were sustainable in 2013.  Hospitals and payers are still expected to fund most exchange activity.

On the other hand, 49 organizations derive 50 percent or more of their funding from public sources. Of these, 17 anticipate that public funding will remain their most substantial funding source in the future.

Many HIEs are seeing market opportunities in support of new payment initiatives. Sixty-five are already supporting or participating in an accountable care organization (ACO), according to eHI’s survey. To support ACOs and other advanced payment models, organizations plan to offer alerts to providers (83), connectivity to other networks (83), patient access to their information (78), analytics (74), and image exchange (69) in the future. Ninety organi­zations currently use Direct, primarily for transitions of care, the survey found.

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