On more than one occasion, I, and many others have wondered aloud about the sustainability of HIEs. Chief among the reasons are that government funding would run out and there would be nothing left to entice the original participating members to pay fees to keep the organization intact.
Well, it's starting to look like HIEs are finding their footing. According to the 2012 Report on Health Information Exchange, published by eHealth Initiative, HIE “organizations are 'bullish' about surviving without federal funding.”
This, quite frankly, is fantastic news for health organizations who have invested the time, the knowledge and the money to connect to local and/or state designated HIEs across the country. It's also good news for providers wanting to qualify for the Meaningful Use Stage 2 requirement of securely exchanging patient data.
That's not the only positive news about HIEs in the report:
- There were 322 HIEs in operation in 2012, an increase of 27% from 2011.
- Support of Direct Project is growing. 50 HIEs offer Direct communication and 53 more plan to support it in the near future. A mere 25 offered Direct in 2011.
- More than half of HIEs are currently supporting accountable care organizations (ACOs) and/or patient-centered medical homes (PCMHs), or they plan on doing so in the future.
Let's dig a little deeper.
Point one was expected because in 2011 not all the guaranteed federal funding had been distributed to HIEs who were awarded funding. More of these HIE grant recipients are up and running now that they have members on board, government cash in hand, and plans for developing the architecture required for data exchange.
Point two: Direct Project offers tremendous potential to move interoperability forward, eliminating many of the interfacing and security obstacles HIE members encounter. The rate of growth for Direct's use between 2011 and 2012 was 100%, and this rate of increase is likely to continue. We predict that 90% of our customers will be evaluating Direct and IHE-based Web Services in 2013 due to Meaningful Use and ACO participation.
Why? Meaningful Use Stage 2 requires the secure transport of patient summaries between facilities, while the lifeline of an ACO is the efficient sharing of health information among the members. The Direct Project allows for a simple transport method to push health information to another facility, while IHE-based Web Service allows facilities to query one another for health information.
Point three: imagine if you were the head of a new HIE who constantly was told by health IT experts that the HIE business model was unsustainable. What would you do? Most would work their darnedest to make sure the model was viable long term, and that process would begin by surveying the health data exchange landscape. After the Supreme Court upheld the Affordable Care Act in 2012, the easy bet was that ACOs are where connected health organizations would be headed. Why not provide the data exchange architecture needed to exchange data?
Does all this mean smooth sailing ahead for HIEs? Hardly. More HIEs also means more competition. Supply and demand will inevitably decide the winners and losers in the marketplace. Additionally, patient privacy issues still have yet to be resolved by many states. Deciding statewide opt-in or opt-out rules will determine how providers address data exchange with patients, and not something to be taken lightly.
Additionally, only 88 of the 322 HIEs are considered to be in advanced stages of development, per the report. The term advanced stages is a bit misleading in this case. According to the eHealth Initiative, these advanced HIEs at a minimum are actively exchanging health data. What that tells me is that 234 of the 322 HIEs are not yet exchanging data. An HIE is an HIE in name only if it does not exchange health data. Liability issues (trust), lack of a true business case, interface challenges, issues obtaining patient consent, and a lack of internal processes are likely all reasons for a rather low percentage of organizations who meet this "advanced" threshold.
There obviously are many hurdles that need to be overcome before HIEs as we currently know them are fully functional. Will they fade away and be absorbed into a local ACO? Time will tell, but the key takeaway in these findings is that interoperability is on the rise; organizations that require interoperability are everywhere; and ACOs offer a true business case for actively exchanging your health data with external organizations.