Study: HIE on the rise, but financial viability remains ‘Achilles’ heel’

Participation in health information exchange (HIE) is on the upswing, with 30 percent of hospitals and 10 percent of ambulatory practices now linked to one of 119 U.S. operational HIEs, according a study in the July issue of Health Affairs.

While more providers are joining HIEs, the future remains uncertain as 74 percent of HIEs report struggles with developing a sustainable business model. “There is a substantial risk that many current efforts to promote HIE will fail when public funds supporting these initiatives are depleted,” wrote Julie Adler-Milstein, assistant professor in the school of information and school of public health, University of Michigan, in Ann Arbor, and colleagues in the report.

In the study, researchers surveyed 172 organizations (out of 221 attempted) that exchange clinical data between independent entities between August and November 2012 and compared the results with planning and operational efforts reported from surveys they conducted in 2009 and 2010.

Of the 172 respondents, 119 were actively exchanging clinical data, compared to 75 identified in a 2010 survey. The majority of operational efforts were not for profit and had been exchanging data actively for less than two years, according to the report.

Hospitals and ambulatory practices most commonly participated in HIEs, and they were the most likely to pay for it, the researchers found. However, HIE participation was significantly lower among payers, independent pharmacies and other groups.

The most common types of data exchanged included test results and summary care records for patients. For inpatient settings, discharge summaries were the most popular type of data exchanged and for ambulatory settings, clinical summaries were the most common type of data.

While HIE adoption grows geographically and among providers, sustainability issues loom as many rely heavily on government grant funding. “Taken as a whole, these findings are good news for current federal policy efforts but raise real concerns about the future,” the authors wrote.

And although growth is substantial, HIE use has yet to reach critical mass, as two-thirds of hospitals and 90 percent of physician practices do not participate in HIEs. The authors recommend that policy makers place “explicit focus” on helping HIEs achieve financial sustainability , with a look at how all stakeholders who benefit from it can support them in the long term.

“Given the substantial public investment in health information exchange to date, a top policy priority must be determining how exchange efforts can generate enough value to be viable,” Adler-Milstein et al concluded.