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On the successes and failures of various HIE models

Health information exchange is growing, with the number of entities on the rise along with those entities’ interest in HIE standards such as the Direct Project.

With more than 250 organizations now facilitating health information exchange, three general HIE models have emerged.

There’s the centralized HIE, in which all patient data is “pushed” to a single, centralized database. This makes it easy to manage data and run queries against it. However, centralized HIE is costly, presents logistical issues and runs the risk of numerous duplicate records.

In federated HIE, on the other hand, organizations “pull” the patient data they need from other organizations’ databases. While operations is easier, since there is no single clinical data warehouse to maintain, security is harder, since entities must make sure that anyone trying to access patient data is, in fact, authorized to do so. Pulling data for reports is quite challenging, too.

Hybrid health information exchange blends the two HIE models, with patient data stored centrally — but only for a finite period. This addresses the need to compile quality reporting data but not, unfortunately, the high cost of a central database. If the cost hurdle can be overcome, then the hybrid HIE model may come to define the future of health information exchange.

Along with the differing data exchange models are differing organizational structures — there are private entities, the state HIEs funded by the HITECH Act and public-private partnerships — and differing HIE business models. Some charge membership fees; some don’t. Some receive state funding; some don’t. Some receive reimbursements from payers; some don’t.

Ultimately, though, health information exchange success comes not from selecting one of the HIE models over another. Instead, it’s a matter of getting the right stakeholders to participate in the organization, meeting the needs of all stakeholders — even if it means eschewing business or funding opportunities because not everyone thinks it’s a good idea — and, above all, integrating information exchange into existing clinical workflows to minimize disruption.

Finding the right HIE model to make these three things happen won’t guarantee success, but it will go a long way.