Health plan: HIE progress slow, not-so-steady

Progress toward achieving true health information exchange is slower than anyone involved expected--and some leaders don't think it's working at all.

Mary Franz, executive director of health information technology for the Local Initiative Health Authority of Los Angeles County--known as the L.A. Care Health Plan, which covers 1.5 million people in the county--is one HIE leader who is skeptical that progress will speed up, she told Healthcare Informatics in a recent interview.

L.A. Care has had a $16 million regional extension center (REC) grant since 2010. The center works with area physicians in implementing electronic health records and connecting with other clinicians. It's looking to have its REC status extended through April 2015.

"The most important learning for me so far is this: that it's going to be a long process and it's going to be iterative," Franz said. "And this is not new to the information technology adoption curve in any other industry; but in healthcare, the IT adoption curve is not a very well understood model."

Physicians have high expectations for technology adoption, but using tablets, smartphones and apps "doesn't translate" into core information systems adoption, according to Franz.

"In fact, I'm not sure that the HIE framework, as it exists right now, is viable; it's a very, very difficult topology to have to navigate, with hundreds and hundreds of different interfaces," she said. "And it's not simple, like the ATM model in banking."

Franz says she'd love to see an HIE that has a business management point of view, not subsidized by the state. A private HIE has the potential to really have legs, she said.

A University of Michigan study published last summer found that 74 percent of exchanges responding to a survey reported struggling to develop a sustainable business model. Federal backing for HIEs ended in January.

According to a report published last month by Black Book Rankings, 83 percent of the nation's public HIEs are stalling without that federal backing. Without more effective processes, revenue streams and business models, as few as 10 of the operating public HIEs are expected to still be in business by 2017, the report's authors found.

Respondents to a survey published this past November by the eHealth Initiative indicated that they expect hospitals will remain the most important source of HIE funding in the future. However, they also expect a greater role for private payers.

To learn more:
- read the full interview in Healthcare Informatics


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