RAND: HIEs are still 'experiments' in need of further study

The jury is still out as to whether health information exchanges (HIEs) are delivering as promised, since it appears that very few of them have been evaluated, according to a new study published in the Annals of Internal Medicine.

The study, conducted by the RAND Corporation and supported by a grant from the U.S. Department of Veterans Affairs, reviewed selected databases from January 2003 to May 2014. The researchers found that while there are more than 100 HIEs currently operating in the U.S., only 13 have been examined; of those, six were in New York state.

Moreover, the study concentrated on HIEs and hospital emergency departments, where there was some evidence that HIEs reduce utilization and costs. However, the effects on other outcomes are unknown, and more research is needed to identify and understand success factors related to HIEs.

The study also pinpointed additional problems with HIEs. Their use was low, comprising only 2 to 10 percent of patient encounters, and use varied widely. Many HIEs continue to struggle to justify themselves from a business standpoint, although newer payment models that rely more on data sharing and advanced functionalities may help.  There also are barriers to acceptance of HIEs, including workflow and interface issues encountered by providers and privacy and security concerns by patients.

"When considering the large public investments in HIE and its postulated critical importance to healthcare delivery, more studies are needed to identify what does and does not work and in what contexts," the researchers concluded. "Until better evidence is available, all HIEs should be viewed as experiments and evaluated as such."

HIEs are viewed as the primary way to exchange EHR data, especially insofar as EHRs themselves are too variable to share data directly. Interoperability is also a cornerstone of the Meaningful Use incentive program; if HIEs don't work well, that goal may be harder to attain. The Agency for Healthcare Research and Quality (AHRQ) recently updated its handbook on HIE assessment to help those involved in HIE development.

To learn more:
- here's the study abstract