Dueling Health Information Exchanges Thwart Patient Care

Competition among Michigan's regional health information exchanges has hampered the development of a statewide HIE, according to an article in Crain's Detroit Business.

In 2006, the piece notes, then Michigan Governor Jennifer Granholm adopted a plan to encourage the growth of "sub-state" HIEs, of which there are now six in Michigan. It was expected that these exchanges would have interconnected through a statewide HIE by this year. Instead, the two largest HIEs are each trying to win enough market share to become statewide exchanges themselves.

The biggest problem this presents to Michigan healthcare providers is that the two big HIEs--Great Lakes HIE and Grand Rapids-based Michigan Health Connect--use different HIE vendors and are on different platforms. So if a hospital or physician practice signs up with one of these HIEs, they can't exchange data with providers that belong to the other exchange.

Despite their competition, the leaders of the two HIEs told Crain's that they have been talking about ways to share data and hope to reach an agreement within a year. But meanwhile, some large healthcare systems are reluctant to join any exchanges outside their enterprises, because they don't know which will survive.

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The article quotes Jim Lee, vice president for data policy of the Michigan Health and Hospital Association, as saying that a single statewide HIE, rather than competing regional HIEs, would be the best solution for the state. The author also cites a study in the Annals of Internal Medicine that found "states that have promoted the use of a single HIE, including Indiana, Maryland, and Massachusetts, have not only moved more quickly ahead in the goal of exchanging patient information, but those HIEs also are more financially stable."

But Jennifer Covich Bordenick, CEO of the eHealth Initiative, which tracks HIE activity nationally, told InformationWeek Healthcare that's the wrong lesson to draw from the situation in Michigan. "You don't resolve the issue [of competition] by picking one HIE. You resolve the issue by having standards and systems that talk to each other. If you don't do that, you're going to have the same problem in another six months when another HIE pops up. So the issue isn't which HIE to pick--it's connecting all of them."

This has become a pressing issue of late, she said, as more and more physicians acquire EHRs and want to exchange clinical data. "Michigan is the microcosm of what we're seeing around the country."

To underscore that point, the preliminary results of eHealth Initiative's 2012 HIE survey show that competition from other HIEs and EHR vendors may be affecting participation in community exchanges. Of the 127 HIEs that completed the survey, "36 reported that competition from other HIEs was an important challenge, and 50 expressed concern about competition from health IT system vendors offering exchange solutions," the eHealth Initiative report said. Altogether, 67 HIEs--more than half the total--reported that stakeholder concerns about the HIEs' competitive position in the market were a barrier to getting the providers to participate.

This didn't used to be a problem, because HIEs were few and far between and concentrated on separate geographical areas. Now many of them are overlapping, and they're trying to grow to cover the cost of their infrastructure.

Bordenick doesn't see competition per se as a problem, and she rejected the notion that HIEs should be confined to particular states. "Healthcare doesn't stop at state lines," she pointed out, citing the Washington, D.C. market, which encompasses the District of Columbia, Maryland, and Virginia.

Although HIE vendors originally focused on, and are still competing for, the business of healthcare systems that want to connect with their own providers, Bordenick said they have to progress beyond that business model.

"We're not just looking for an EHR that can help a consumer navigate one hospital; we're looking for an EHR that combines five different [healthcare] entities," she said. "It's a paradigm shift, and we've got to move forward. Patients are demanding this: they want their information and they want it now. That, along with the market pressures, is going to move this forward. HIEs are going to have to find a way to communicate with each other."

However, she admitted, it's not clear yet how that will happen. The Health IT Standards Committee and the Health IT Policy Committee--advisory bodies to the Office of the National Coordinator of Health IT--are "working on this vigilantly," she said. But, while the Meaningful Use Stage 2 rules include a number of provisions aimed at facilitating health information exchange, she said, they don't cover interoperability among HIEs.

"There's an issue of patient matching, so the different systems recognize each other," she noted. "We really need to have a focused effort nationwide."

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