HIEs remain in nascent stage despite rapid growth

Two facts pop out of the new Black Book Rankings survey about health information exchanges (HIEs). First, 80 percent of hospitals and 97 percent of responding physicians said they're not currently participating in HIEs, according to Healthcare IT News. Second, 85 percent of hospital executives said their HIE plans were driven mainly by the industry-wide move toward accountable care organizations and new methods of reimbursement.

One reason for the very low participation of physicians in HIEs is that most doctors don't yet have electronic health records capable of exchanging data with other healthcare providers. While surveys show that more than half of physicians have some kind of EHR, a recent government report indicated that only about a third of doctors had systems that could be classified as "basic" EHRs--and that definition doesn't include the ability to exchange clinical information. Catherine DesRoches, senior scientist for Mathematica Policy Research, told iHealthBeat that she thinks only 12 percent to 15 percent of doctors have fully functional EHRs today.

Assuming that's the case, why would just 3 percent of doctors say they participated in HIEs? Two possible reasons come to mind: community HIEs are available in only a small percentage of markets, and only a small fraction of healthcare systems have created private HIEs.

In July 2011, KLAS, an Orem, Utah-based research firm, reported that the number of live public HIEs--which connect unrelated providers--had risen to 67 from 37 the previous year. The number of operating private HIEs—which link healthcare systems to affiliated providers—had jumped to 161 from 52 in 2010. A recent report by Chilmark Research indicated that HIEs grew more than 40 percent in 2011, with most of the growth coming in private HIEs. But if you do the math, that means there are only a few hundred HIEs, most of which involve only one hospital or healthcare system and their affiliated providers.

So when Farzad Mostashari, the National Coordinator of Health IT, recently urged clinicians and patients to demand that relevant information be made available at the point of care, he was reacting to the need for much more dramatic progress on the HIE front. Some of that progress will undoubtedly occur as a result of the proposed Meaningful Use Stage 2 regs, which place a strong emphasis on HIE. But, judging by the Black Book survey results, many providers recognize that the need for information exchange goes far beyond Meaningful Use.

Eight of ten respondents expect their HIE budgets to increase significantly by 2014, and 95 percent anticipate they will be included in an HIE by mid-2013. Coupled with the fact that hospitals are doing this mainly to prepare for accountable care, these findings suggest a major, broad-based shift in strategy is taking place. But it's unclear how this will play out in practice, and whether the enterprise-based HIEs that are predominant today will gradually evolve into networks that are truly interoperable across care settings.

Although private HIEs may initially meet the needs of accountable care organizations, ACOs will eventually require  data exchange across business boundaries to improve care coordination. The big question is whether competing healthcare entities will recognize that cooperation is in everyone's interest. - Ken