The national market for software and services to support health information exchanges is a mile wide and an inch deep, but in Doylestown, Pa., its 4-year-old HIE is doing just fine, even though revenue from user fees still doesn't cover its operating costs.

Both the broad and the narrow perspectives were presented in an educational session about exchanges at the College of Healthcare Information Management Executives Fall CIO Forum on Thursday in San Antonio.

Giving the big picture was Jason Hess, executive vice president of KLAS Enterprises. The Orem, Utah-based HIT market research firm conducted a survey of HIE organizations in April.

Hess said KLAS surveyors “validated” that 35 products were in actual use in some form of clinical information swapping. No single vendor dominates the HIE software market. Only 13 of the products had been installed in six or more active HIEs, Hess said, but 10 vendors' products serve 70% of all validated HIEs, with 25 products serving the remainder, he said.

According to KLAS, 71% of HIE leaders surveyed said the systems they use have the needed functionality, but more than half—between 55% and 65%, depending on whether they were a privately or publicly run HIE—required physicians to leave their EHRs and go to the HIE site or portal to use the exchange.

Rich Lang is vice president and CIO of 247-bed Doylestown Hospital, which sponsored the HIE that traces its roots back to a call for help from community physicians to deal with the Y2K threat back in 1999.

The solution then was to host a Y2K compliant practice management system for the docs, and, a few years later, when leaders of two of the larger physician groups asked for help in providing them with an EHR, the Doylestown Clinical Network was born.

The HIE has been up and running since 2007 and now provides the link that connects the hospital and 150 community physicians. The exchange moves patient information on allergies, medications, problem lists and lab results.

The bare-bones cost for a physician to join the exchange is $60 a month, but it's more if the practice is supplied an EHR.

Expenses for the exchange run to more than $1 million, with the hospital covering about 40% of the cost, Lang said. Doylestown Hospital also lost about 5% of its ancillary revenue because of the exchange as physicians had access to the data and stopped ordering duplicative lab tests and imaging.

But hospital leaders see subsidizing the HIE is in its long-term interests with the advent of accountable care organizations and patient-centered medical homes.

“You're not going to make money here, but you're going to provide qualitative benefits,” Lang said. “If you get into and ACO, it's going to be there for you.”

Providers who join the HIE are obliged to obtain consent from their patients to participate in the exchange, using a paper consent form that also explains what data will be used, by whom and for what purpose.

Lang said providers are not legally obliged to seek a patient's permission or tell them where their information it going, according to the exception in the privacy rule for treatment, payment and other operations allowed by the Health Insurance Portability and Accountability Act. But, Lang said, “if you're not transparent about what you're doing with that data, even if you don't have to under HIPAA, then I think you're remiss in a fundamental responsibility.”

Lang said less than 1% of Doylestown area patients opt out of the exchange.

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