Although most health information exchanges are not operating with fully sustainable business models and many networks are struggling to prove their worth, information technology officials are optimistic about the progress some exchanges have made in sharing electronic health data.
The fourth annual survey of HIEs from eHealth Initiative surveyed 130 initiatives outlines that struggle. More than half, or 56%, of respondents, said developing a sustainable business model is a "very difficult" challenge, up from 45% who said the same in the 2006 survey. Defining the value of the exchange was called "very difficult" by 43% this year, up from 30% last year.
This year's survey garnered 35 fewer responses than last year, and information for the nonscientific study is gathered mainly through a Web site in which participants self-report their information, eHealth said.
Information exchanges, including community-based HIEs and larger ones like regional health information organizations have been battling with the issue of survival beyond an initial government grant and enthusiastic supporters. Overall, the eHealth Initiative's results show a field that is slowly maturing, according to Janet Marchibroda, chief executive officer of the Washington-based organization, which has been conducting the survey since 2003. "There is an emerging business case, but it's early," she said.
Securing upfront funding became slightly easier this year53% said it was "very difficult" as opposed to 57% in 2006and the number of stakeholders who are willing to pay to participate in HIEs has increased as well. While they all received federal startup funds, many of them are now using ongoing revenues from hospitals, payers, physician practices and laboratories to continue operations, the report said.
Of the respondents, 32 initiatives said they are operational and transmitting data used by their HIE stakeholders, compared to 26 operational initiatives in the organization's 2006 survey.
The number of HIEs calling themselves operational is likely inflated, however, because of the differences in scope of various exchanges, said Marc Overhage, president and CEO of the Indiana Health Information Exchange, which participates in the survey. The number of truly operational exchanges is likely 12 to 15, he said.
The progress is not so much in the number of exchanges, but in the "maturing field" of HIEs, he said. When eHealth Initiative conducted its first survey four years ago, there was a lot of energetic enthusiasm around HIEs, and now participants are delving into the details to determine what makes an exchange valuable, he said.
"We're starting to see patterns emerge," he said.
The largest driver behind HIEs remains the desire to improve healthcare quality, up to 94% in 2007 from 91% last year, according to the survey. The biggest value in exchanges is the ability to send clinical data, such as laboratory results, over the network, which is done 34% of the time, up from 26% of the time last year.
That's the type of information that participants are willing to pay for, and that's where the sustainable business model comes into play, according to Marty LaVenture, director for the Center for Health Informatics and eHealth in the Minnesota Department of Health. The state department oversees the Minnesota eHealth Initiative, which provides guidance and tools for communities that build HIEs.
Minnesota's HIEs are making progress "slowly but successfully," LaVenture said. The key is in developing a business model and defining standards that are valuable to all the participants, which is something the public/private collaboratives build together. "If we're all going to move, we have to move together," he said.
Laboratory results, quality reporting and chronic disease management are the three largest areas in which HIE participants find value, said the Indiana Health Information Exchange's Overhage. By using a mix of transaction and monthly subscription fees, the information exchange has created a sustainable model, he said.
EHealth Initiative, which supports national information exchange efforts, is developing business cases for communities trying to build HIEs, and the best way to demonstrate the value of exchanges is to study those that are successful, she said. "We're on the ground with markets," Marchibroda said.
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