Lessons from ONC's state HIE program

Engaging major healthcare players is key to state efforts to set up health information exchanges, according to a study of the Office of the National Coordinator for Health IT's state HIE program.

The paper, from NORC at the University of Chicago, analyzes state efforts in Iowa, Mississippi, New Hampshire, Utah, Vermont and Wyoming.

The researchers found that in some states, large health systems delivered participants and data to the HIE, while in others, large systems acted as competitors and the absence of their data hurt the HIE's value proposition.

Setting tangible, intermediate goals to keep stakeholders energized was one important lesson from the analysis. Defining incremental processes and goals also allowed states to make course corrections when necessary.

All six states reported IT-related challenges, including limitations within electronic health records, lack of interoperability between systems, as well as data capture and quality issues. Some states worked with multiple developers to address these issues. Many are looking to ongoing development and the adoption of data standards as long-term solutions, according to the paper.

Most of the grantees are embracing value-added services as a means to ensure sustainability. Five of the six states plan to charge subscription fees.

Among the policy implications from the study:

  • It's hard to understate the importance of states' role in leadership and coordination of HIEs.
  • There is a critical need for strong, ongoing support for standards and interoperability.
  • A provider- or federal-led effort may be required to meet HIE goals and change perceptions about interoperability.

Twenty HIEs recently announced they have formed the Strategic Health Information Exchange Collaborative (SHIEC), an effort, they say, to provide economies of scale, promote business models for the sustainability of HIEs, increase awareness of HIEs and work with legislators and policymakers.

Though Stage 2 of the Meaningful Use program was supposed to boost patient data-sharing, interoperability remains elusive, and attestation numbers for the program remain underwhelming.

To learn more:
- read the paper (.pdf)