Effort to promote HIEs failing

It comes as no surprise to many observers that regional health information exchanges are struggling financially.

Research published this week in Health Affairs concluded that “there is a substantial risk that many current efforts to promote health information exchange will fail.”

Fewer than one in four HIEs responding reported that revenues from exchange participants covered their operating costs. Fewer than half were being financially supported by payers.

Why? That question is unanswered even in this otherwise thorough status report on HIEs.

The researchers surveyed 221 health information exchange efforts, of which 172 responded to their survey requests, and 119 of which were actively exchanging healthcare information. These exchanges allow the movement of clinical information among disparate healthcare information systems and providers in a geographic area, to provide better and more efficient healthcare. The movement of data is also useful to public health authorities in analyzing population health.

Test results were the records most often exchanged—by 82% of HIEs—with various forms of patient summaries trailing at 79% to 61%, depending on the type of summary and the venue of care.

The conventional wisdom is that patients and payers, not providers, are the beneficiaries of HIT. The researchers warned that policymakers need to find ways to help HIEs become financially viable, most notably through “approaches to ensure that all stakeholders who benefit from health information exchange pay to support it.”

One of their suggested remedies is a mandated fee per claim; another is a dedicated state tax.

Why are so many payers sitting by watching HIEs struggle? “I really think there are three factors,” said one of the researchers, Julia Adler-Milstein from the University of Michigan School of Public Health Adler-Milstein. “I think we really haven't showed them the evidence that they've benefitted.” That would require some well-designed research to remedy, she said.

“The second factor is there is this free-rider problem,” she said. “If I (as a payer) invest in an HIE, it will benefit my competitor,” who might not pay for the HIE service.

“Then, there is really a chicken or the egg problem,” she said. Insurers' thinking is, “We don't want to invest until we know which ones are viable.”

Follow Joseph Conn on Twitter: @MHJConn