'Community' HIEs may need help to compete with 'enterprise' models

"Community" and "enterprise" health information exchanges (HIEs) have different priorities and goals, and while they could be complementary, currently they compete with each other, according to a new report in Milbank Quarterly.

HIEs are a major focus of data exchange and the Meaningful Use program. The researchers--from Indiana University School of Public Health and Texas A&M Health Sciences Center--wanted to determine why some health systems join community HIEs, which bring in a broad spectrum of participating providers, and why others create their own enterprise HIEs.

The authors conducted semi-structured interviews with 40 HIE leaders, policy makers and healthcare executives from 19 different organizations. They found that health systems that create enterprise HIEs of affiliated desired trading partners do so to as a "stepping stone" to leverage their own data and technology for their strategic goals, such as to participate in accountable care organizations and other payment reforms. 

Several interviewees affiliated with community HIEs indicated that enterprise HIEs also sought to alter local market dynamics by tying only some providers to the exchange.

In contrast, the primary reason that providers joined a community HIE was to obtain information about their patients receiving treatment from unaffiliated providers. They often were public exchanges and more focused on the public good. Community HIEs also provide services to small hospitals, and population level data for government and public health reasons.

Both types of HIEs reported vendor issues as barriers. Community HIEs reported additional barriers, such as patient consent and differing strategic priorities among participants.The Meaningful Use program also was seen as a barrier for community HIEs.

"Health policymakers might try to encourage the type of widespread information exchange pursued by community HIEs, but the business case for enterprise HIEs clearly is stronger," the researchers say. "The sustainability of a community HIE, potentially a public good, may necessitate ongoing public funding and supportive regulation."

HIEs continue to evolve over time. Their use overall has increased, but still remains low. Some HIEs are attempting to make themselves more attractive to providers by offering a wider array of services.

To learn more:
- here's the study abstract