Nearly 70 percent of hospitals are building or planning to build the infrastructure for a health information exchange, according to a survey of 200 hospital executives by Beacon Partners, a health IT consulting firm. However, many respondents were concerned about the high startup costs of HIEs and the lack of capital to invest in them.
Annual budgets for HIEs are low: 38 percent of respondents said their facilities had budgeted less than $1 million, and 21 percent had no budget. But it was unclear from the survey whether this was due to insufficient funds or whether HIEs were a low priority for hospitals.
The business case for HIEs remains uncertain, despite the Meaningful Use requirement that hospitals show they are capable of exchanging clinical information with other providers. Nevertheless, two-thirds of respondents saw an HIE as a "positive move" for their organization, and 42 percent said it would improve patient outcomes.
Among the top expectations for HIEs are improved primary care connectivity, improved transitions of care, and better clinical quality reporting. The most important reason for having an HIE, respondents said, is patient safety and fewer medical errors. Other key goals included increased availability of patient data across care settings, increased communication among practices, and a reduction in the number of redundant tests.
The survey showed some ambivalence about what form an HIE should take. For example, while 31 percent of the respondents said that they were interested in a "community hospital/health network," which sounds like a private HIE, nearly as many said that state or local government initiatives had caught their attention, meaning they wanted to be part of a public exchange.
Similarly, "clinical summary exchange for care coordination" was the second most cited operational reason for forming an HIE, just behind "connectivity to EHR/clinical documentation." While an HIE could enable the exchange of clinical summaries between inpatient and outpatient EHRs within an enterprise, it could also allow hospitals to trade data with non-affiliated practices and other entities.
Among the survey's other findings:
- 64 percent of respondents said CIOs should be in charge of HIEs.
- About half of respondents have not created a department, oversight group or executive role to handle their HIE initiative.
- The majority of respondents favored a single-vendor solution over a best-of-breed approach for inpatient systems (73 percent), ambulatory departments (68 percent), and physician practices (53 percent).