What We Know About the “States” of HIE

Jan. 9, 2015
The ONC recently released a report on State HIE Program to determine how it did in establishing statewide data exchange across the country. What’d they find? Some progress, some challenges intact, and a whole mess of questions.

During the Christmas/New Year’s two-week window, the Office of the National Coordinator for Health IT (ONC) released a report on the State Health Information Exchange (HIE) Program. The report was written by NORC, at the University of Chicago.

This may sound like a broken record, but the release of this report comes at a time when HIE sits at a crossroads. I know I’ve said it before, but I’ll say it now and I’ll say it again, until it’s no longer at a crossroads. HIE is at a crossroads, specifically statewide exchange efforts.

Some, thanks to the efforts of people like Dev Culver in Maine, have succeeded and are doing quite well. Others are not. The report, in 42 pages, did a fine job of detailing this reality. It was a nice overview of the successes and challenges of HIE at large, and yes, it comes at a critical time. With the end of State HIE Program, it’s unclear where the larger data exchange efforts will go. Will they successful or will they fall apart without funding?

For the report, NORC looked at six states. They did a bang-up job of picking six states that, while obviously having unique problems, represent the nation at large. The six states were Iowa, New Hampshire, Wyoming, Mississippi,  Utah, and Vermont. If they picked six winners or six losers, it wouldn’t have told the complete tale. These are six HIEs that are at varying stages of development.

It was broken up into various sections, including how each grantee enabled exchange from a technical perspective, what policy-levers they used, how they engaged stakeholders, and what were their plans for sustainability. So what did the report tell us about HIE at the end of the State HIE Program? Let’s dive in and break down each section.

Technical Perspective: Everyone has taken on Direct exchange, meaning participants can “subscribe to regional- and state-level entities that facilitate exchange across unaffiliated organizations for directed exchange.” Interest in Direct has grown over time, the report’s authors indicate. Despite this, workflow challenges with Direct are still present. The lack of electronic health record (EHR) integration, for one, is frustrating. On the flip side, Query-based exchange, available in four of the six states, is based on one of three technical models: federated, centralized, or hybrid. The federated model seems to be favored by those who have done it, but they caution say it’s costly and time-intensive to connect through. Centralized participants say it allows for easy data access, is good for analytics, and offers a consolidated view. However, it requires more up-front costs. Later on, authors of the report talked about the challenges related to the HIE developers. Not shockingly, those who worked closely with their developer did better than those who did not. Also, HIEs are leaning towards best of breed, rather than a single HIE vendor, due to the latter’s limitations. This was the case in Utah.

Policy Levers: The key finding here was the importance of accountable care organizations (ACOs). In states where there was a rise in ACOs, HIEs were found to be fundamental. This was the case in both Vermont and Iowa, which had progressed more than some of the other states in the report. Another finding was opt-in and opt-out. Basically, opt-in is a problem. It was an impediment in Utah, until policy ensured that data for Medicaid, Medicare, CHIP, and Public Health Employees Program beneficiaries would be in the HIE

Stakeholder Engagement: This is where the men were separated from the boys, as they say. States that were able to get big-time health systems and organizations on board (Vermont, Utah) early on made a lot more progress than those that did not (Wyoming, Mississippi). The latter did have representatives from two big hospitals, but failed to establish a relationship with Medicaid. All six states said the regional extension centers (RECs) were an important part in engaging the community. One element to overcome engagement challenges was the establishing incremental goals to give the stakeholders quick, early wins. In the states where HIE succeeded, this was a much better option than the “build and they will come” approach. Another interesting find was how elements out of their control—i.e. market consolidation—affected progress. Markets with more consolidation (Vermont) had a clearer path towards engagement of large health systems.

Sustainability: If the men have been separated from the boys in stakeholder engagement, what happens in sustainability? The strong men get separated from weak? An HIE that has already shuttered (Wyoming) wasn’t even included in this section. What did the states that had success find? Value-added services! It’s the term, like crossroads, that cannot be overstated enough. In Vermont, they were looking at analytics. In Utah, it was alerts and Stage 2 meaningful use criteria. Iowa has a whole bunch of value-add: ePrescribing, CCD exchange, lab and radiology results, etc. While the fee structure is different among all these states, the idea behind sustainability is not.

The report, while a bit long, is worth a read. There are other important sections, payer engagement and intrastate exchange, that give us a nice view on the “States” of HIE. So what was the impact of the State HIE Program? This won’t shock you but there was a lot of progress in laying a foundation, there are still some walls to be climbed, and there will be a lot of uncertainty in place for the near future.

As the authors of the report write, “It’s too early to determine the full impact of the State HIE Program.” They later mention that as the training wheels come off, most states are in a nice position to move forward. Will they?

We just don’t know yet. We’re at a crossroads, remember?

Please feel free to respond in the comment section below or on Twitter by following me at @GabrielSPerna

Sponsored Recommendations

Bridging the Health Plan/Provider Gap: Data-Driven Collaboration for a Value-Based Future

Download the findings report to understand the current perspective of provider and health plan leaders’ shift to value-based care—with a focus on the gaps holding them back and...

Exploring the future of healthcare with Advanced Practice Providers

Discover how Advanced Practice Providers are transforming healthcare: boosting efficiency, cutting wait times and enhancing patient care through strategic integration and digital...

Unlock Staff Capacity, Increase Safety and Reduce Operational Spend - Realizing ROI from AI enabled RTLS

Unlock staff capacity and enhance safety with AI-enabled RTLS! Join us on June 25th to learn how these systems can reduce operational spending and complexity, improving efficiency...

New Research: The State of Healthcare Cloud Security and Compliance Posture

Compliance & Security Debt Awareness Could Have Prevented Change Healthcare & Ascension Healthcare Breaches