The current governance, financing and policy barriers limit state health information exchanges from reaching their full potential, the Brookings Institution said in a report.

The authors found that state exchanges have been successful in “establishing organizational frameworks, building technology-based connections and bringing relevant groups to the table for discussion,” according to the Feb. 8 report (PDF).

But the issues that are of concern to state health information exchanges include difficulty in reaching consensus on strategy and approach, identifying consistent revenue streams and ongoing questions about whether the state, compared to a local or regional setting, is the proper basis for the exchanges.

“Many states have encountered significant obstacles at implementing data sharing and connecting healthcare providers,” authors Darrell West and Allan Friedman wrote. “There are political, financial, technological and organizational challenges that have complicated the task of making significant changes. These difficulties have slowed the efficacy of megachange in healthcare.”

West is director of governance studies and founding director of the Center for Technology Innovation at the Brookings Institution. Friedman is a fellow in governance studies and research director of the Center for Technology Innovation at Brookings.

The report, which analyzed health information exchanges in Indiana, Massachusetts, New York, Tennessee and California, found that the progress of the exchanges varies. The authors wrote that there are 255 state, regional and metropolitan health information exchanges in the U.S., as of mid-2011, and the state and local exchanges have developed different business models with some requiring subscriptions from local providers and others functioning as a public utility.

West and Friedman also said clear performance metrics would support progress on health information exchanges.