HIEs grow to 193 in 2009, increasing cost savings
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According to the Sixth Annual Survey of HIE, the eHI identified 43 additional HIEs that are functioning, but which were not part of the 2009 survey. Overall, the eHI has identified and collected information on 193 active HIE initiatives in the United States.
When respondents completed this year's survey, the promise of the American Recovery and Reinvestment Act (ARRA) loomed large. "The February enactment of ARRA provides much needed support to an industry that has struggled in a financially challenging landscape," the authors noted. The federal government is projected to spend at least $300 million in support of HIE activities in 2009 and 2010.
The report found that the number of initiatives involved in a HIE is growing. Specifically, 67 first time HIE initiatives responded to the eHI survey. Overall, there are at least 193 active initiatives involved in a HIE, and 150 of those initiatives responded to the survey. Notably, eHI identified 43 additional HIEs from the 2008 survey that are still functioning, but which did not complete this year's survey.
Of note, the number of HIEs that reported being operational has sharply increased. Overall, 57 HIE initiatives reported being operational in 2009, up from 42 initiatives in 2008--a nearly 40 percent increase from 2008.
Forty operational initiatives reported cost savings resulting from their HIE. Operational initiatives have identified cost savings in a variety of areas, including:
- 26 reduced staff time spent on handling lab and radiology results;
- 24 reduced staff time spent on clerical administration and filing;
- 17 decreased dollars spent on redundant tests;
- 11 decreased cost of care for chronic care patients; and
- 10 reduced medication errors.
The survey also found that a HIE has had a positive impact on physician practices, allowing them to become more efficient without disrupting care. Operational initiatives report the following impacts for practices that utilize the exchange:
- Improved access to test results and resultant efficiencies on practice (28);
- Improved quality of practice life (i.e., less hassle looking for information, getting home sooner at the day's end) (24);
- Reduced staff time spent on handling lab and radiology results (23); and
- Reduced staff time spent on clerical administration and filing (22).
A HIE can help reduce costs for a number of different stakeholders, but hospitals and physician practices could see the greatest return on investment (ROI). The 2009 report said that operational initiatives most often reported ROI from hospitals (21) and physician practices (19).
The survey found that services most offered are results delivery, such as laboratory or diagnostic study results, which was reported by 44 initiatives, connectivity with EHRs (38 initiatives), clinical documentation (31 initiatives), alerts for providers (31 initiatives) and e-prescribing (26 initiatives).
More HIEs are exchanging data, with increases in the type of data exchanged nearly across the board. The number of initiatives reported currently exchanging data in the following areas:
- Laboratory data increased to 49 initiatives, up from 26 in 2008.
- Medication data (including outpatient prescriptions) 48 initiatives are currently exchanging.
- Outpatient laboratory increased to 45, up from 25 in 2008.
- Outpatient episodes increased to 43, up from 23 in 2008.
- Radiology results increased to 39, up from 23 in 2008.
- Emergency Department episodes increased to 36, up from 27 in 2008.
The eHI also found that HIE initiatives are becoming less dependent on federal funding. Seventy-one initiatives reported they are not dependent on federal funding, up from 64 initiatives in 2008. The number of organizations which state they are dependent on federal funding checked in at 30 initiatives, only one more than in 2008. Also, 90 respondents hope or expect to receive funds through the ARRA.
For the first time in six years, initiatives identified "addressing privacy and confidentiality issues" as the most pressing challenge they face, surpassing "developing a sustainable business model."
Lastly, the survey found that the most significant challenges impacting HIE initiatives today are: addressing privacy and confidentiality issues--HIPAA and other (93 initiatives identified this as a pressing challenge); defining the value that accrues to the users of the HIE (92 initiatives); and developing a sustainable business model (90 initiatives).