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Vital Signs Blog

Blog: Multimillion-dollar fed HIE effort produced some gains, some failures

The federal push to promote state health information exchanges has resulted in hits and misses, according to a report commissioned by the Office of the National Coordinator for Health Information Technology at HHS.

In early 2011, the ONC awarded $565 million to 56 states and territories. The number of acute care hospitals using “directed” health information exchange increased from just over 100 hospitals in 2011 to just under 1,000 in 2013, according to the report by NORC at the University of Chicago (PDF). Similarly, participation by “ambulatory entities” increased from 4,500 in 2012 to 21,000 in 2013, the report authors said.

Seven of the original participants in the four-year program are “no longer operational,” the report said. In the long run, maybe more HIEs will go belly up.

Directed exchange, also known as a “push” transaction, is a basic form of interoperability, such as when a hospital sends lab results to a primary care physician's office, where the sender has an established communications link with the recipient.

The number of acute care hospitals participating in more advanced “query-based” exchanges also increased from less than 400 in 2011 to 2,000 in 2013. The number of ambulatory entities performing query-based exchanges increased from 2,200 to 8,800 over the same period, the report said. Query exchanges occur when the requesting provider doesn't know whether other providers have a given patient's medical records, but searches for them using basic identifiers such as the patient's name, data of birth, gender and other identifying characteristics.

Not all of these gains in interoperability and information exchange can be attributed to this one program, the authors said, since the federal initiative “did not operate in a vacuum.” In fact, grant recipients “were encouraged to pursue solutions based on their own local needs,” the authors said.

Many of the HIE program investments, however, “are likely to pay dividends in the coming years, as HIE becomes more established, more widely available, and more interoperable,” the NORC researchers said. “As a result, additional program impacts may emerge downstream that cannot be captured at present.”

The financial sustainability of regional and state-wide health information exchanges has been a dicey proposition long before federal dollars came pouring into them.

The report said that grantees expressed concerns about the financial sustainability of their HIE efforts, wondering whether they could demonstrate long-term value to stakeholders. Long-term sustainability requires that grantees seek out new financial contributors (including payers, ACOs, and long-term care providers) and offer them reasonably priced services that address their needs and priorities for exchange, according to the report.






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