Health information exchange initiatives are on the rise across the country, but only a handful of HIEs are both operational and sustainable. Their numbers must increase to help meet the demands of providers
There are 234 HIEs identified by the Washington, D.C.-based eHealth Initiative, which has conducted the Annual Survey of Health Information Exchange since 2004. This year, 199 HIEs participated in the survey. Of that number, the organization identified 73 HIEs as operational, meaning that they are currently transmitting data. That's an increase from 57 operational HIEs in the 2009 survey.
The increase in operational health information exchange initiatives is encouraging, but only 18 of the 73 are considered to be truly meeting the initiative's definition of "sustainable": They are breaking even on operational funding and are not relying on federal money to sustain their business. "We've used that as the pinnacle of sustainability," said organization CEO Jennifer Covich Bordenick during a recent presentation of the survey results.
Operational, sustainable HIEs are exchanging data among the stakeholders that pay a subscription fee to participate. Hospitals and health plans are the two largest stakeholder groups paying fees to the 18 sustainable HIEs, followed closely by public health clinics, according to the survey.
The results demonstrate that health information exchange initiatives can indeed survive, said Rachel Block, deputy commissioner of the Office of Health Information Technology Transformation in the New York State Department of Health. "There's been a lot of handwringing over whether HIEs can be sustainable," she said during the survey results presentation.
The services offered by HIEs range widely, however, and it's uncertain whether exchanges provide consistency in those services, Block said. How to align the work that HIEs have been doing for several years with new federal initiatives also raises questions, she added. "I think we need to wait and see."
There's been a lot of handwringing over whether HIEs can be sustainable.
Rachel Block, deputy commissioner, Office of Health IT Transformation, New York State Department of Health
Information exchange is a significant component of the meaningful use requirements that providers have to follow if they wish to receive reimbursements through the federal government's Electronic Health Record Incentive Program. The final criteria for Stage 1 of meaningful use were released last month by the Centers for Medicare & Medicaid Services in conjunction with the Office of the National Coordinator for Health IT, or ONC.
Those requirements are reflected in this year's eHealth Initiative survey, according to the organization. Many HIEs said they are starting to examine their functions and tailor the services they provide to the federal criteria. "HIEs are nearing meaningful use in terms of their strategies," said Trudi Matthews, director of policy and public relations for HealthBridge, the HIE that serves the greater Cincinnati area. As the market changes and more federal requirements come online, however, what the exchange model will look like is up in the air. "Largely it's been on the regional level," she said, adding that might change.
In the eHealth Initiative's annual survey, addressing government policies came in as the second-largest issue that health information exchange initiatives said they face, behind sustainability. Financial stability has been one of the most significant concerns for HIEs since the organization began conducting its survey, but this year marks the first time government policies were named as a large concern, Bordenick said.
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