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Health information exchanges are making progress toward meaningful use

An eHealth Initiative study says health information exchanges are making progress in facilitating meaningful use for electronic health records.

After years on shaky legs, health information exchanges (HIEs) are beginning to stand on their own two feet financially, even as they contribute to more effective and efficient health care. And with federal stimulus funds becoming available, HIEs are poised for a growth spurt.

As a sign of increasing maturity, respondents to a recent survey cited patient privacy concerns as a greater issue than financial viability -- a sign that many HIEs are no longer merely struggling to survive but dealing instead with practical treatment issues. The report, “Migrating Toward Meaningful Use, The State of Health Information Exchange,” was published by the eHealth Initiative in August.

An HIE is a collection of standard health care records that are accessible across a network. HIEs have sprung up in many regions across the country, attracting participation of all members of the health care community, especially hospitals and practitioners. Often, a regional health information organization (RHIO) is the primary sponsor of an HIE. Funding for HIEs typically comes from state government grants, hospitals, the federal government and private payers.

A full-fledged health information exchange makes health care records available in an emergency so that conditions can be diagnosed faster and needless tests avoided. Ultimately, local HIEs will be linked together to form a Nationwide Health Information Network. The viability of such a network was recently tested in a staged event: the collapse of a fan at an Indianapolis Colts football game . In the demonstration, the fan was rushed to an Indianapolis hospital and his records were successfully retrieved from Indiana and other states.

The eHealth Initiative survey took the pulse of 150 respondents of 193 active health information exchanges in the U.S., of which 57 are operational. That’s up from 42 operational HIEs in 2008 and only nine in 2004, the first year of the survey.

Ninety-three respondents said that addressing privacy and confidentiality issues are among the most significant challenges they’re facing. That was followed by defining the value to users of the HIE, with 92 responses, and developing a sustainable business model, with 90. It’s the first year that developing a sustainable business model has not ranked first among concerns.

Although 90 respondents said they hope or expect to receive funds through the American Recovery and Reinvestment Act (ARRA) of 2009, 71 said they are not actually dependent on federal funding, an increase from 64 HIEs who said they were financially independent in 2008.

As HIEs become more a part of the health care fabric in their regions they must take steps to accommodate patient access to records, a service that many HIEs do not yet offer.

Other survey findings showed that HIEs are doing their job -- 40 of the operational HIEs reported cost savings. In addition, the exchange of laboratory data took place in 49 HIEs, up from only 26 in 2008. Forty-four operational health information exchanges said that delivery of laboratory and diagnostic results was the HIE service most offered.

As HIEs become more a part of the health care fabric in their regions, the report said that HIEs must take steps to accommodate patient access to records, a service that many HIEs do not yet offer.

The report also noted that the disbursement of ARRA funds in 2010 could yield a very different picture of HIE nationally by the time the 2010 survey is completed, as RHIOs begin spending new funds on many initiatives, including health information exchanges.

The eHealth Initiative and the affiliated Foundation for eHealth Initiative are nonprofit organizations based in Washington, D.C., whose 160 members include doctors, hospitals, health IT vendors, laboratories, pharmaceutical companies and medical device makers.

Stan Gibson is a Boston-area journalist. Let us know what you think about the story; email

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