Different states are trying different approaches to setting up and managing health information exchanges, in some cases after high-profile failures.
In California, for example, the University of California-Davis Health System's Institute for Population Health Improvement is taking on the HIE governance role on behalf of the California Health and Human Services Agency. It will manage the California Health eQuality program, replacing the public, not-for-profit Cal eConnect, reports iHealthBeat.org.
Cal eConnect replaced the California Regional Health Information Organization, which replaced the California eHealth Collaborative--all over the course of eight years--iHealthBeat notes.
Pamela Lane, California's deputy secretary for health information exchange, told the website that Cal eConnect focused on technology upon its start three years ago, but expects the new program to focus on data-driven outcomes. She added that Cal eConnect had been "weighed down" by a large board of directors and the challenges of understanding new technology while still in the startup phase.
In North Carolina, the executive director of the regional Coastal Connect HIE says the organization gained success by rolling out technology slowly to avoid overwhelming providers, and by following up to ensure adoption, reports Clinical Innovation + Technology.
The HIE is funded through subscriptions. Grants are used to finance one-time costs. So far, about 170 practices and 952 unique user accounts are connected through the exchange, according to the report.
Massachusetts launched a statewide exchange this month, the Massachusetts Health Information Highway, managed by Orion Health. It was the first HIE to receive federal funding, a $16.9 million grant approved in August.
Meanwhile in Michigan, two statewide health information exchanges lack interoperability, thanks to their use of competing technology.
In a recent blog post, John Moore, founder and CEO of the Cambridge, Mass.-based Chilmark Research, contends that health information exchange is moving into its second stage, prompted by the release of Stage 2 Meaningful Use rules.
The first stage was "all about the message," he says, or passing simple, message-based transactions and aligning physicians. Public-sector HIEs were intended to report data for public health and give physicians enough information to avoid duplicating tests, he says.
Under Stage 2 Meaningful Use, "messaging in the context of HIE is now passé," Moore writes. He projects significant turnover in the HIE market with the emphasis on value-based contracting and reimbursement, as well as on facilitating delivery of appropriate care across all care settings.
"Our latest end use research finds a market that is full of frustration," Moore warns. "HIEs today simply cannot readily support care management processes across care settings in a heterogeneous [electronic health record] environment."