Health Information Exchanges Struggle With Sustainability

Business sustainability continues to be among the biggest challenges for most health information exchanges, even as new HIEs are starting up and existing ones are figuring out ways to overcome technical and other various hurdles, according to a new report from eHealth Initiative.

The number of HIEs in the U.S. grew 9% in 2011 to 255 from 234 in 2010, according to a recently released annual report by eHealth Initiative, an independent non-profit membership organization that advocates for the use of health IT and studies HIE trends. The number of HIEs tallied by eHI reflects 10 initiatives shutting down or consolidating over the last year, and 46 new initiatives participating in the eHI survey.

eHI has been conducting its Report On Health Information Exchanges studies since 2004, when there were only a few dozen HIE initiatives. That was prior to the passage of the American Recovery and Reinvestment Act's $27 billion HITECH Act, which included more than $564 million in funding to help states launch or expand HIEs.

Among many of the newly counted HIEs this year are private efforts "that don't consider themselves HIEs" but are accomplishing the kind of secure patient data exchange that most HIEs seek to achieve, said Jennifer Covich Bordenick, CEO of eHI in an interview with InformationWeek Healthcare.

Some of those newly counted HIEs include integrated health delivery systems that are facilitating health data exchange among their own network of hospitals and doctors and are expanding their services to include data exchange with non-affiliated providers, Bordenick said.

"It's an exciting time, there's a lot of growth in the private sector," said Bordenick. Many of the newly counted HIEs are healthcare delivery organizations that didn't launch with government funding or depend on that, she said. Also, some of the more mature and most sustainable HIEs are private efforts such as HealthBridge, which serves healthcare providers in Ohio and did not launch with government funding or grants.

Still, while many HIEs are making headway in tackling complicated technology and policy issues regarding patient data exchange, only a small group of the HIEs that participated in the eHI survey meet eHI's definition of having a sustainable business model.

In 2011, only 24 HIEs were considered sustainable, up from 18 in 2010. To be considered sustainable by eHI, an HIE must be in more advanced stages of operations, including no longer being in pilot stage; transmitting data used by healthcare stakeholders; and possibly offering value-add services such as data analytics or quality reporting services in addition to data exchange.

Also, sustainable HIEs must not be dependent on federal or other government funding, but rather be sustaining themselves through revenue-based models, such as subscription fees paid by healthcare providers who participate in the HIE.

"A sustainable business model has been very difficult for many initiatives to figure out, it's very complex to figure out the best model for any particular effort because these exchanges are serving so many different stakeholders, and for the most part are organizations serving the public good," said Bordenick.

However, the consolidation and shakeout that's happening is a positive development for the HIE landscape overall, said Bordenick. "The market is evolving, there's lots of movement" as these efforts mature and learn how to become sustainable, she said. While four HIEs shut down over the last year, another four were consolidated with larger organizations, and two for-profit organizations were purchased.

HIEs typically facilitate the electronic sharing of patient data among many healthcare providers in a region or state. However, at least 113 of the HIEs participating in the eHI survey said they also plan to incorporate services into their offerings supporting the federal Nationwide Health Information's evolving Direct Project. The Direct Project aims to allow healthcare providers to securely send encrypted patient data over the Internet point-to-point, or directly to another trusted recipient. However, unlike the more robust services also offered by most HIEs, Direct Project support won't allow a healthcare provider to query a network of other healthcare providers for all available data about patients.

Also, while the federal government hasn't yet finalized requirements for Stage 2 of the HITECH Act's Meaningful Use program, HIEs are anticipating the need for healthcare providers to expand their electronic interaction with patients. So, in preparation of the upcoming requirements--and also as a way to differentiate their services for the time being--some HIEs are beginning to allow patients to access their health data through the exchanges.

eHI found that 17 HIEs are currently allowing patients to access their health information, 18 others plan to do so over the next year, and an additional 40 exchanges are planning to offer those services within two years.

Meanwhile, although not all federal and state government guidelines have been hammered regarding patient privacy and security, many HIEs are developing their own complex controls over patient privacy, including some offering patients granular "opt in" or "opt out" choices for having their health information exchanged via the HIE.

Whether its patient privacy issues, data exchange models, or other challenges, "HIEs are figuring out ways to handle many of the technical and other questions out there," said Bordenick. "Yet, sustainability continues to be a struggle."

Find out how health IT leaders are dealing with the industry's pain points, from allowing unfettered patient data access to sharing electronic records. Also in the new, all-digital issue of InformationWeek Healthcare: There needs to be better e-communication between technologists and clinicians. Download the issue now. (Free registration required.)