Interoperability issues continue to stifle health information exchange (HIE) organizations' ability to connect, and sustainability remains a struggle, according to the eHealth Initiative's 2013 Health Data Exchange Survey.
A mix of community data exchanges (90 organizations), statewide efforts (45) and healthcare delivery organizations (50) were among the 199 entities that completed the survey, now in its 10th year, according to an announcement. Eighty-four organizations have reached advanced stages of operation, sustainability, or innovation as defined by the eHealth Initiative's developmental framework. Most took one or two years to become operational.
The report says exchanges are maturing rapidly, yet calls interoperability "a great hurdle with little relief in sight." It adds that now is the time for exchanges to demonstrate their value as vehicles for population analysis.
Among the findings:
- Achieving interoperability with disparate information systems is a major concern; 68 initiatives have had to connect to more than 10 different systems; one-fifth (32) had to construct interfaces with more than 25 different systems.
- To overcome interoperability challenges, exchanges would like to see standardized pricing and integration solutions from vendors.
- Many exchanges are not sharing data with competing organizations.
- Exchanges are focusing on functionalities to support health reform and advance analytics.
- Patient engagement remains low amongst organizations exchanging data. Only thirty-one organizations currently offer patients the ability to access their information. While 102 initiatives plan to offer that access, 56 have no plans to do so.
- Patient consent for data exchange generally remains an all-or-nothing proposition. Opt-out is the most common consent model. And 109 organizations do not offer patients the ability to limit sharing of their information based on data type or source.
- While more exchanges have become financially viable, just 52 initiatives (26 percent) indicated that they received sufficient revenue from participating entities to cover operating expenses.
In a University of Michigan study, 74 percent of the exchanges reported that they're struggling to develop a sustainable business model. Yet federal backing for HIEs ends in January, leaving organizations still dependent on that funding scrambling.
The eHealth Initiative respondents still expect hospitals will be the most important source of funding in the future, but also expect a greater role for private payers, and less government money available, such as that recently offered to rural Arkansas hospitals.