Amid doubts about the sustainability of HIEs, the results of the survey are disconcerting, lead author, Anjum Khurshid, director of the health systems division at the Louisiana Public Health Institute, and his colleagues conclude, because without incorporating quality of care and ROI metrics into their business model, many HIEs may not survive.
"The transformational changes that HIEs promise come much later and require trust, evidence-based approaches, perseverance, and collaboration among all healthcare stakeholders. It would be disappointing if the already high rate of HIE failures increased in the next few years as federal funds are exhausted," the report stated.
Bill Rudman, executive director at the American Health Information Management Association (AHIMA) Foundation, told InformationWeek Healthcare that the report is a wake-up call for healthcare stakeholders.
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"I absolutely think it's irresponsible for healthcare provider organizations and leaders not to develop and utilize outcome metrics to measure the efficacy and efficiency of the health information exchange," Rudman said.
The report's authors note that HIEs are a key part of the Nationwide Health Information Network (NHIN) infrastructure that will electronically exchange patient data among providers in different locations. To help HIEs along, approximately $2 billion from the HITECH Act will go toward the development of HIE infrastructure and services. To help NHIN succeed, state, regional, and local HIEs must develop an effective business model that financially supports HIEs well into the future, long after these exchanges stop receiving government funds.
"This means that to convert the stimulus funding into a transformational long-term regional strategy, a case has to be made to private-sector, local, and regional stakeholders to invest in HIE initiatives. While most experts agree with the transformational potential of HIEs to support a system that delivers coordinated, affordable, and quality healthcare services, we lack robust empirical evidence of HIEs improving quality of care and providing value to patients and to participating entities," the report said.
Researchers sought to find out how many fully functional HIEs are using metrics to gauge the impact of HIEs on quality improvement and ROI. With that goal in mind, they identified 96 fully operational exchanges across the country that are transmitting data used by healthcare stakeholders, and that also have sustainable business models.
Responses were received from 21 organizations, of which 18 HIEs met the survey criteria of actually exchanging data as of January 1, 2010. Among the key findings for the 18 HIEs:
-- Fifty percent of the HIEs reported using metrics for quality improvement. Of these, most organizations tracked quality improvement in a number of different areas related to clinical outcomes and some preventive measures, including readmissions, vaccination rates, diabetes management, and cancer screening.
-- More than half of the organizations have used or plan to see reduction in duplicative tests or procedures, improved communication among providers, and improved health outcomes to measure the impact on ROI. Thirty-nine percent of respondents listed specific metrics currently being used to determine ROI. Forty percent of the organizations that were using some ROI metrics also believed more evidence was needed to show a positive impact of HIEs.
-- Ten respondents (56%) said that based on the performance of their own HIE, they believed that HIEs show positive ROI, while eight respondents (44%) felt more evidence was needed to make such a determination. Two respondents who believed HIEs show positive ROI stated that they have not used metrics to calculate ROI but are in the process of developing ROI metrics. Seventeen respondents (94%) believed that HIEs improve quality of care.
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