Declining number of public HIEs raises concerns about interoperability

The number of public health information exchanges (HIEs) has dropped, raising concerns about the ability to achieve widespread clinical data exchange, according to a new study in Health Affairs.

The study, conducted by researchers at the University of Michigan, found an 11 percent drop in state and community HIEs from 2012 to 2014, from 119 to 106. It’s the first decline in HIEs in the history of such surveys, which began in 2007. It’s also the first measurement of the number of HIEs since federal funding aiding their development ended.

The HIEs that were still operational reported that only half of them were financially stable, and all of them were running into problems that affected their success, such as an unsustainable business model, lack of integration of the HIE into provider workflow and lack of funding. Key stakeholder participation was also low, which indicates that the HIEs may hold limited value.

"Our results suggest early signs of a shakeout as these efforts, which have always struggled to find sustainable business models, try to prove they are creating value," Julia Adler-Milstein, one of the authors, said in an announcement touting the study. "We also find that they are trying to prove this by making a strategic shift to supporting new models of delivery and payment. This is likely a good move but whether they will be successful is an open question."

In a related study, researchers found that the behavior of EHR vendors may impact a hospital’s use of HIE. They reviewed more than 2,900 hospitals that adopted the EHR for the vendor that controlled market share. The hospitals that used the dominant vendor in their market engaged in HIEs 45 percent more than other hospitals. However, if a market was competitive, HIE engagement was lower, indicating that vendors may be putting up barriers to exchange in order to gain a competitive edge. The only exception was Epic; when it was dominant in a market, hospitals using Epic engaged in more HIEs.

"HIE as a process will undoubtedly continue to be pursued and we will figure out how to do it well," Adler-Milstein said. "The big open question is what types of entities will govern that process? Right now there appears to be a horse race between community and state HIE efforts and those led by EHR vendors. And if the latter "win" we need to be wary of whether they are connecting needed providers in ways that are best for the patient."

To learn more:
- here’s the abstract of the decline study
- read the abstract for the vendor study
- check out the announcement