Provider trust can cause an HIE to sink or swim

Amid the ongoing debate over the sustainability of multi-stakeholder health information exchanges, the National eHealth Collaborative (NeHC) has released a report explaining why some HIEs have been successful, profiling a dozen of them. A common denominator among working exchanges? Trust among its participants, the report's authors say.

Successful HIEs work hard to build trust among the participating healthcare entities. Aside from assuring data security, "the culture, policies, and procedures of the HIE regarding data usage must assure participants that no stakeholder will gain a competitive advantage at the expense of others," the report says. Because there are less likely to be major competing healthcare systems in rural areas, the report notes, it is easier for HIEs in those regions to attract participants, many of whom need support in building their own health IT infrastructures. (Despite that assessment, however, CareSpark, a rural HIE based in Kingsport, Tenn., recently went under because it couldn't get local providers to work together.)

The report's authors also maintain that to create a sustainable business model, HIEs must persuade local stakeholders that they offer enough value to be worth supporting financially. "Reduced data distribution costs and increased staff productivity are the major reasons why participants are willing to pay for the services offered by these HIEs," they write. The most prevalent form of financial support is subscription fees.

Aside from the uncertainty of financial support from providers, other obstacles to health IT success include policies and procedures to meet complex security requirements, gaps in interoperability standards and lack of adherence to existing standards, according to the report.

All but three of the 11 profiled HIEs in the private sector are financially self-sustaining. (The twelfth is the U.S. Department of Veterans Affairs.) Interestingly, however, several of the participants believed that payer support would be essential to long-term sustainability.

The private-sector participants in the study include: Availity; Big Bend RHIO; HealthBridge; HealthInfoNet; Inland Northwest Health Services; MedVirginia; Quality Health Network; Rochester RHIO; Sandlot; SMRTNET; and THINC.

The study by NeHC--the successor to the American Health Information Community, a Bush-era federal advisory group--was funded by the Office of the National Coordinator for Health IT.

To learn more:
- read the NeHC report (.pdf)
- see this iHealthBeat summary