Brookings: Consensus from policymakers necessary for HIE success

Private sector buy-in and an alignment of state and federal policies is essential to the long-term success of health information exchanges, a paper published today by The Brookings Institution concludes.

The effort to implement HIEs is a "megachange" challenge--one that impacts multiple parties in both "big and complex" manners--authors Darrell West and Allan Friedman write.West serves as vice president and director of Governance Studies for Brookings, and is the founding director of the institution's Center for Technology Innovation (CTI); Friedman is a fellow in governance studies and is the CTI's research director.

In reviewing how a select handful of states handled HIE implementation, West and Friedman determine that Indiana and Massachusetts have made "significant progress" in terms of overall organization, financing and delivery, while Tennessee and California have shown far less progress. Indiana, the authors say, was helped by its early innovator status; the launch of the Indiana Network for Patient Care nearly two decades ago served as a model for the creation of the Indiana Health Information Exchange and Indiana Health Information Technology.

Massachusetts, meanwhile, benefited from "well-developed hospital and state legislation ... designed to make healthcare more affordable and accessible," which was enacted during Republican Governor Mitt Romney's administration. 

Tennessee, on the other hand, has had issues connecting regional exchanges with one another, as well as "problems sustaining parts of its HIEs." The authors frequently reference the failure of the CareSpark regional health information organization due to a subpar business model.

A combination of budgetary problems and size contributed to California's struggles, according to the West and Friedman. "It's funding model relies heavily on federal money, especially for the state HIE," they write.

Overall, the authors also note that political divisions and market fragmentation have plagued HIE implementation nationwide. "The less consensus on broader objectives, the more difficult it is for policymakers to make decisions, implement exchanges and resolve conflicts," they write. "Stakeholders need to cooperate and pull together in order to make meaningful progress on HIEs."

To learn more:
- read the full paper (.pdf)