A successful and sustainable model for health information exchange (HIE) is a key building block of the Nationwide Health Information Network. But concerns about long-term funding and a lack of evidence to support the value of HIEs have made it difficult for them to grow and thrive. The National eHealth Collaborative (NeHC) conducted a study of 12 fully operational HIEs to help the health care community better understand these issues and work toward a common solution.
The NeHC report, Secrets of HIE success revealed, shares some common success factors as well as barriers to growth and sustainability for HIEs. The report offers a detailed profile of 12 established HIEs, examining each organization’s critical success factors, barriers to growth and sustainability, business model, connectivity strategies, technology partners, strategic initiatives and future outlook.
Some of the common success factors include:
- Aligning a diverse group of stakeholders with HIE priorities: HIE leaders specifically emphasized the importance of ongoing and effective stakeholder engagement.
- Establishing a consistent and trustworthy brand identity: The culture, policies and procedures of the HIE regarding data usage must assure participants that no stakeholder will gain a competitive advantage at the expense of others.
- Making difficult choices to ensure that the goals of all stakeholders are being met: Many of the HIEs studied deliberately chose not to pursue grants or business opportunities that seemed to lack unified stakeholder support or did not appear to advance the organization toward its shared vision.
- Understanding clinical workflows and managing change: For several HIE organizations,managing change means integrating applications into existing workflows with minimum disruption to the practice and bringing users online as quickly as possible.
Of the HIEs studied, common barriers to growth and sustainability include:
- Complex privacy requirements: Most of the HIEs studied believe that requiring patients to opt-in to the HIE is a barrier to progress, while using opt-out consent is an important factor to success.
- Gaps in interoperability standards and lack of rigorous adherence to existing standards: Continuously having to invest considerable resources to achieve consistency of data and presentation diverts time and money from activities to grow the enterprise.
While the business model and strategy for each organization studied is unique, they do share some common characteristics. Many of the HIEs profiled achieve sustainability by charging subscription or transaction fees to help cover operating expenses, while using grant money from the private sector to finance new ventures, grow services or expand geographic footprints. Several initiatives believe that financial support from payers is essential to the long-term sustainability of the HIE business.
HIE leaders are cautiously optimistic about the emergence of accountable care organizations (ACOs), but also concerned that health care organizations might use ACOs to gain a competitive advantage, putting a damper on the willingness of HIE stakeholders to share data.
All of the organizations studied offer basic HIE services, but many are looking to evolve from data interchange businesses to application solutions providers. Some HIEs are helping hospitals and physicians achieve EHR meaningful use, and some are offering patient portals and other premium services.
For state and local health information exchange initiatives struggling to grow and succeed, the NeHC report offers some great insight into what works and what will be a challenge.