Public Vs. Private Health Information Exchanges: Competition Escalates

Community and statewide health information exchanges (HIEs) are becoming increasingly concerned about competition from enterprise HIEs and health IT system vendors offering HIE solutions, according to the 2012 report on Health Information Exchange by the eHealth Initiative (eHI).

However, the report also finds that the number of operational public HIEs is continuing to increase and that the majority of HIE initiatives are supporting new reform models such as accountable care organizations and patient-centered medical homes. Because of the impact of healthcare reform and Meaningful Use, which will require enhanced information exchange in phase 2, the momentum in this sector should grow in the next year or two, said Jennifer Covich Bordenick, CEO of eHI, in an interview with InformationWeek Healthcare.

Overall, eHI identified 322 HIE initiatives this year, compared to 255 in its 2011 report. Because of changes in its survey methodology, however, eHI rejected responses from some HIEs, and it couldn't reach or obtain responses from others. Therefore, its 2012 report is based on just 161 HIEs, down from 196 last year.

Of the respondents, 88 were classified as "advanced" or operational HIEs. The others were in some stage of planning or early implementation.

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The majority of the responding HIEs (101) were freestanding organizations. The rest were organized by a healthcare organization (28), a state or state-designated entity (39), or some other kind of entity (25). Most of the initiatives (123) allowed competing healthcare providers to participate if they met HIE requirements.

According to Bordenick, it typically takes two or three years for an HIE to develop from a conceptual to an operational stage. The eHI report shows that 46 HIEs are nearly ready to become operational, which means they will probably join the ranks of advanced HIEs in the next year, she said. The number of operational HIEs increased by 13 from 2011 to 2012.

The distribution of advanced HIEs across the country remains uneven. New York has 11 HIE initiatives and California has 10, but many predominantly rural states have 3 or fewer. Bordenick said this is unlikely to change, because HIEs cluster in the urban areas where the healthcare business is concentrated.

Sustainability remains the top challenge cited by survey participants. But in comparison to 2011, when government policy and mandates and coping with technical barriers were among the top issues, HIEs responding to the 2012 survey were more concerned about such matters as privacy and confidentiality and lack of funding.

Many HIEs raised new issues, such as stakeholder concerns about their competitive position in the market and competition from health IT system vendors. These were also among the most important issues of operational exchanges.

Bordenick viewed these sentiments as reflective of rising competition in the HIE market overall. "HIEs aren't used to competition, and as the market matures, we're going to see more and more of that," she said.

At this early stage, accountable care organizations tend to be based in either hospital systems or physician groups, many of which exchange health data only within their own organizations. In addition, healthcare systems are going through a new wave of consolidation, increasing their motivation to exchange data within rather than between enterprises.

Bordenick said these trends are "a real concern" for public HIEs. "You have these proprietary HIEs popping up because the market needs them," she said. "But in the end, organizations will see it's much more valuable to be able to exchange data outside of your group."

"We see this again and again: Organizations that are completely closed end up opening up, because it makes sense. Patients don't stay within the bounds of [healthcare enterprises]. They move around; they switch health plans; they switch doctors, they move, get fired, get a different employer. All of those are moving parts and pieces, and you can't control for that. So I think exchanges will adapt, and ACOs will have to adapt."

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