Health information exchange adoption and use is experiencing "considerable growth," but only in a few states, according to a report from NORC at the University of Chicago researchers.

Directed transactions between 2011 and 2013 more than tripled, according to the Examining the State HIE Cooperative Agreement Program. Patient record queries increased more than fourfold.

The increases can only be attributed to a few states, however. In the second quarter of 2012, for example, Indiana, Colorado and New York accounted for more than 85 percent of transactions and in the third quarter of 2013, Michigan, Colorado, Indiana, New York and Vermont accounted for more than 85 percent of the total.

There were several lessons learned, according to the report. Several common key drivers eased the implementation of HIE, encouraged participation by hospitals and providers and accelerated progress. Those include involvement of diverse stakeholders, the initial service offerings, the offical responsibilities of governing bodies, starting simply and building on over time and the role of delivery system reform.

Among the challenges of HIE implementation are the greater resource intensity of developing HIE infrastructure and services than anticipated, the need for common standards and incentives, relationships with EHR developers and HIE vendors and sustainability.

"Our evalution findings demonstrate that there is no one-size-fits-all solution with HIE; instead, development and use of HIE is predicated on the state and local environments within which it exists," the authors wrote.