Enterprise exchanges owned by healthcare organizations account for most of the 40% annual growth in the market.
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A new report from Chilmark Research shows that the health information exchange market grew more than 40% in the past year. However, most of that growth came in privately sponsored, enterprise health information exchanges, rather than in public health information exchanges that seek to connect providers across regions or states.
The main reasons for the rapid health information exchange growth, according to Chilmark, are Meaningful Use criteria--which will require interoperability between systems at transitions of care, such as hospital discharges--and the impending changes in reimbursement methods that will necessitate greater care coordination.
"Everybody realizes they're going to have to tie their systems together with their affiliates if they're going to have any hope of surviving payment reform," Chilmark founder and CEO John Moore told InformationWeek Healthcare.
While public health information exchanges could help providers meet these challenges, healthcare organizations tend to approach information exchange in the context of their own positions in the marketplace. Moreover, they don't necessarily want to wait for public health information exchanges to reach their areas. So it's not surprising that the bulk of health information exchange growth is now on the enterprise side.
Although healthcare providers are still installing electronic health records (EHRs), Moore noted, many of them already recognize the need to leverage the data generated by EHRs to improve quality and do population health management--a critical requirement for accountable care organizations. So they need health information exchanges to coordinate patient care across care settings.
This strategy doesn't necessarily require the use of a public health information exchange. Moore cited St. Louis' healthcare systems, which agreed to connect their private exchanges so that doctors who are on the staffs of more than one hospital don't have to deal with multiple health information exchanges. But he acknowledged that might not work so well in other metropolitan areas where competing systems are at each other's throats.
A recent article in the Journal of the American Medical Informatics Association points out that the rapid evolution of enterprise-based health information exchanges, coupled with the advent of Direct clinical messaging, has undermined the ability of public health information exchanges to survive. On the other hand, some healthcare systems use both private and public health information exchanges. For example, CentraState Health System, based in Freehold, N.J., has built an internal health information exchange to connect with its community doctors, but has also joined Jersey Health Connect, a regional exchange that includes 17 other hospitals.
The Chilmark report reviews and compares 22 health information exchange vendors. A number of them have been taken over by larger companies in the past year or two. For example, the top two health information exchange firms by market share, Axolotl and Medicity, are now owned by UnitedHealthcare unit Optum and Aetna, respectively. Siemens has acquired MobileMD, and CareFx is now part of Harris Corp.
Some large corporations playing in the health information exchange space have partnered with smaller firms to accelerate their efforts. AT&T is partnered with Covisint, and Verizon with MedFx, Moore noted. Microsoft has been using a health information exchange from HealthUnity of Bellevue, Wash., in conjunction with its Amalga analytic application; last year, Microsoft combined Amalga with GE's health information exchange assets in a new company called Caradigm.
The health information exchange vendors in the Chilmark report all offer some analytics and reporting capabilities. While limited, these applications have progressed far beyond what is available from most EHR vendors, Moore said. "That's a sad commentary on the stage of the [EHR] market," he added.
Even top-rated EHRs still have little ability to exchange data directly with other systems, he pointed out. Market leader Epic has a health information exchange called Epic Elsewhere that is supposed to do this, but other vendors have told Moore that Epic remains a closed system. In contrast, he said, Cerner has taken a more open approach, adopting the standardized Integrating the Healthcare Enterprise (IHE) protocols and partnering with other vendors.
"They have made it clear that they want to provide a platform that allows others to build a solution on top of it," he noted. In the long run, he said, EHR vendors that take this approach should come out ahead because open platforms are more congenial to innovation than closed systems.
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