Rich Daly | February 18, 2015
Technological barriers have limited health information exchange (HIE) participation to only 31 percent of hospitals and 12 percent of physician practices.
Feb. 18—Healthcare providers are moving on from struggling public health information exchanges (HIEs) to private versions amid a growing need for patient data as part of the move to quality-based payment systems, a new survey found.
Among the findings of a nationwide survey by Black Book Research was that the share of multiprovider networks and hospital systems considering private HIEs for standardized sharing of patient data has risen to 72 percent this year from 33 percent in 2013.
“Most public HIEs are struggling with flawed business models and are failing to provide meaningful connectivity, according to 97 percent of payers, 86 percent of hospitals, and 73 percent of physicians,” the survey reported.
Despite the crucial role of HIEs in allowing healthcare providers to implement accountable care in payment models, by the end of fourth-quarter 2014, only 31 percent of hospitals and 12 percent of physician practices participated in a public or private HIE. Data exchange has lagged far behind providers’ adoption of electronic health records (EHRs), a basic version of which 97 percent of hospital and 83 percent of physician practices had adopted in 2014. Fully functional EHRs were limited to 69 percent of hospitals and 48 percent of practices.
Public HIEs were initially seeded with $548 million through the 2009 Health Information Technology for Economic and Clinical Health Act but continue to struggle to achieve self-sustainability. Meanwhile, the number of private, self-sustaining HIEs had reached 152 by 2014, according to the survey.
HIEs were supposed to provide a way for different EHR systems in a region or community to share data among the providers and payers using them. But that appears to be happening infrequently.
For instance, 48 percent of hospitals and 91 percent of physicians viewed competing EHRs with HIE capability as roadblocks to developing and harmonizing data standards. Among the common barriers to successful HIE implementation, according to 80 percent of respondents, are garden-walled EHR systems and data ownership or hoarding.
In addition, 70 percent of surveyed health insurers rejected participation in public HIEs, while their preference for payer-owned HIEs and data-sharing networks developed by HIE vendors has surged from 40 percent in 2013 to 86 percent in 2014.
HIE Benefits
Despite the barriers, hospitals remain focused on achieving ROI from HIE. Among the financial benefits that they see HIE as most likely to provide are better control of admissions and readmissions, and collaboration with accountable care organizations (ACOs) and patient-centered medical homes, according to the survey.
The survey found that 98 percent of healthcare organizations view privately run community/regional HIEs as the preferred choice for comprehensively achieving ACO deliverables. Only 3 percent of ACO managers surveyed found operational public HIEs capable of meeting their data requirements as currently configured and funded.
“Challenges and barriers remain—most notably funding and sustainability, variations in how interoperability standards are implemented, provider adoption, disparate electronic medical records, and privacy and security—but they are being tackled and overcome,” the report’s authors wrote. “HIE will be a vital foundation for new healthcare payment and delivery models such as accountable care and patient-centered medical homes.”
The survey’s authors concluded that insurers, which benefit the most from connectivity, will be the primary source of financial support for exchanges and will drive the most successful HIE initiatives.
“Providers are simply not benefiting financially yet from HIE development”, Doug Brown, managing partner at Black Book Research, said in a release. “Without proven worth or certain return, the shift to payer investment in private HIEs was inevitable with value-based care emerging.”
The polling included nearly 2,000 health plan members/patients, 800 independent and employed physicians, 700 hospital executives, 1,200 insurers, and 500 health information technology vendors.
Source: HFMA