The focus of most HIEs, for example, is still on secure clinical messaging, which is inadequate for cross-enterprise care coordination. Queries of databases for patient information needed at the point of care account for only 2% to 10% of HIE transactions, the researchers estimated.
Other observers have also pointed out that health data exchange is still rudimentary. A recent Health Affairs study said that the most common functions of the 119 operational public HIEs were to transmit lab results, clinical summaries and discharge summaries. And while that paper said there had been a big increase in the number of HIEs capable of exchanging Continuity of Care Documents (CCDs) -- a requirement of Meaningful Use stage 1 -- few EHRs can yet integrate the data components of CCDs into their structured fields.
[ EHR interoperability continues to face hurdles. Read more: Sharing Electronic Medical Records Still Too Hard. ]
John Moore, CEO of Chilmark, told InformationWeek Healthcare that according to HIE vendors, most ambulatory EHRs haven't been able to generate CCDs that other EHRs can consume or do queries using a record locator service. Except for some limited use of query-based transactions to get basic data on patients presenting in ERs, he said, "The value that HIEs provide to the ambulatory sector, where 80% of care takes place, is pretty limited."
Specifically, the Chilmark report said, HIE capabilities are fairly effective for lab orders and results, clinician messaging and portal access. But they're poor for notifications and alerts and record queries across networks, and limited in areas like access to disparate EHR data, patient engagement, clinical quality reporting and analytics.
The report emphasized the need for HIEs to provide cross-enterprise capabilities in these and other areas such as care planning, medication reconciliation, and referral management. Yet Moore confirmed that private HIEs -- most of which are confined to single enterprises -- are growing much faster than the regional and statewide HIEs. He doubts that the many of the latter will develop sustainable business models, but acknowledges that private HIEs may not be able to collect all of the required data.
"There's possibly a role for public HIEs if they can provide fairly lightweight services," he said. "For example, they could show where patients are going out of network. That's the big issue right now for organizations with capitated contracts."
Meanwhile, he pointed out, HIE vendors are no longer vying to build exchanges funded by government grants. The Office of the National Coordinator of Health IT (ONC) expended around $750 million, he said, on statewide HIEs and Beacon communities. "Now all that money has been allocated," he said. "That's why some of the bigger players that have made a run at this market have pulled out. They didn't capitalize on that market opportunity and so they said, 'We're out of here.'"
Among the companies that have exited the HIE market, the report said, are Verizon and ACS. Also contributing to the market's consolidation are purchases of leading HIE vendors. Besides the acquisitions of Axolotl and Medicity a couple of years ago by United's Optum unit and Aetna, respectively, Humana recently bought Certify Data Systems, used by many Cerner customers, and Allscripts has purchased dbMotion, which is popular among its clients.
The strongest HIE companies, according to Chilmark, are Medicity, Orion Health (an independent), and RelayHealth (owned by McKesson). Certify, dbMotion, and InterSystems are ranked in the second tier, and the third tier includes CareEvolution, OptumInsight, and Surescripts/Kryptiq.
In terms of progress toward the capabilities that the market wants, Chilmark gives the highest score to CareEvolution, a small Minneapolis-based firm that has robust analytics. Close behind CareEvolution are GSI Health, based in New York, and Alere.
However, there's still a big gap between what provider organizations need and what current HIEs can deliver. "HCOs [health care organizations] need more from their HIEs than ever before -- more functionality, more use cases and better reliability, availability and serviceability," noted a Chilmark blog post. "No vendor is remotely close to being able to assemble an HIE 2.0 solution right now."