Lack of ROI, quality metrics jeopardizes HIE sustainability

Health information exchanges must develop metrics to gauge their impact on quality improvement and show return on investment to continue to convince stakeholders of their value, researchers say in a study published at Perspectives in Health Information Management.

Though health information exchanges provide a "necessary foundation" for accountable care organizations, the long-term sustainability of many organizations is not clear--and the tech market for HIEs remains in flux as it's all being sorted out.

"The last decade has seen significant progress in HIE technologies and substantial investments in HIT adoption, yet the lack of evidence on the value delivered by such efforts remains a major hurdle in making a strong case for both adoption and investment at the local level," the authors say.

The study aimed to look at metrics being used to pursue continuing investment by communities, healthcare systems, the government and others. To gauge this, the researchers sought out HIEs at least in Stage 5 of development as of January 1, 2010, ultimately working with just 18 responding organizations, a key limitation of the study.

The researchers learned that most HIE respondents operate as nonprofit organizations, serve fairly large patient populations and have annual budgets of more than $1 million. Hospitals, ambulatory care clinics, and laboratories are most likely to participate in electronic HIEs, and they're most likely to exchange test results, medication summaries and ambulatory care patient information, in that order.

Yet, just 10 of the organizations said that based on the performance of their own exchanges, they believed that HIEs show positive ROI, while eight said they needed more evidence to make that claim. Two respondents who believed HIEs show positive ROI stated that they have not used metrics to calculate ROI, but are in the process of developing those metrics. Seventeen of the respondents said they believe HIEs improve quality of care.

According to the respondents, prime ways to show ROI include less duplicative testing, quality improvement efforts, care coordination and improved readmission rates. Vaccination rates, diabetes management and cancer screening were among the metrics used to measure quality improvements.

A Vanderbilt study, for instance, estimated savings of $1.9 million through 12 Memphis-area emergency departments' use of HIE data to reduce admissions.

In moving beyond one-time federal funding, HIE organizations must develop standards of performance or jeopardize their ability to contribute to the Nationwide Health Information Network, the authors say.

"HIEs are emergent organizations and it stands to reason that they would experience growing pains," Kyle Murphy, Ph.D., writing for EHR Intelligence, said of the study."But given the millions in government grants that many HIEs are apparently squandering, few are likely to sympathize with the heads of these organizations if they refuse to get their act together and, more importantly, their books in order."

To learn more:
- here's the study
- read the EHR Intelligence post


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