Regional information exchanges in peril? Think again

A new Harvard study published in the Annals of Internal Medicine questions whether regional health information organizations (RHIOs) will ever be able to function on their own. What's interesting about the survey is that its data is substantially the same as that in the latest survey of the eHealth Initiative, an organization that promotes RHIOs (better known today as regional health information exchanges). Yet the eHealth Initiative sees promise where the Harvard researchers see failure.

The Harvard researchers found that only 75 of the 197 known regional HIE initiatives were up and running, with only 25 not dependent on government grants. Similarly, the eHealth Initiative notes that last year, there were 73 operational initiatives, up from 57 in 2009, and 18 of the operational HIEs were financially independent.

The slow progress is viewed by the Harvard researchers as evidence that the regional HIEs were having trouble becoming self-sustaining. In contrast, the eHealth Initiative report states, "Sustainability is an attainable goal for health information exchange organizations. There is a small but critical mass of sustainable organizations."

To support that contention, the organization pointed out that 107 of the HIE initiatives were not dependent on federal funding, up from 71 in 2009.

The Harvard team also said that the operational HIEs were offering few services. In most communities, the researchers said, they were providing only basic information, such as lab results and discharge summaries, and that they couldn't help providers very much with meaningful use.

The eHealth Initiative also found that most of the operational HIEs provided lab results and discharge summaries, as well as medication and allergy data and emergency department reports. But most of them also supplied connectivity to electronic health records and clinical summaries for care transitions. Those functions, plus results delivery, are crucial to meaningful use. Moreover, 44 HIEs allow patients to view their records--another meaningful use requirement.

The Harvard team is right in one respect: the number of regional HIEs in operation remains small, and the number that can exist without government grants is even smaller. In a recent interview with another publication, lead author Ashish Jha commented that many HIEs are overly optimistic that they can get providers to pay for their services, and most payers don't seem interested in supporting the HIEs.

Both of these observations are on the mark. There are exceptions--such as Blue Cross Blue Shield of Tennessee's creation of Shared Health, now an independent company that builds HIEs--but most payers have not come to the table, just as most haven't helped physicians acquire EHRs. Similarly, except for hospitals in Indianapolis, Cincinnati, and a few other places, healthcare systems have done relatively little to support regional HIEs.

While this lack of interest contradicts hospitals' rhetoric about wanting to improve care coordination, the economic reality is that regional HIEs don't support their business strategies. From a business point of view, hospitals mainly are interested in 1) beating their competitors and 2) aligning with their physicians in pursuit of goal No. 1 and other aims. HIEs that hospitals own can help advance them toward these goals better than regional HIEs.

On the other hand, the federal government has announced grants totaling $564 million to help states build statewide and regional exchanges. This money is going to "state-designated entities" that are independent of particular healthcare systems--although their initial focus is on hospitals and large groups. In Wisconsin, for instance, the state is assembling a network that includes most of the big provider groups, plus an existing HIE in Milwaukee. In Maryland, the state-designed entity is connecting the 10 dominant hospital systems in the state.

Whether all of this will continue after the grant money runs out still depends on the support of the healthcare systems. They might be more willing to cooperate if Meaningful Use requires them to exchange information in Stages 2 and/or 3. - Ken