The 14-hospital system will join 32 other providers that are sending data to Healthcare Access San Antonio, an exchange whose territory stretches from the Oklahoma border in the north to Corpus Christi south on the Gulf Coast, the organizations said this week in a news release. HASA handles nearly 2.2 million patient records and supports about 2,400 HIE users.
HASA is one of nine health information exchange organizations in Texas and about 150 nationwide.
For decades now, exchanges have gone by various names and have had varying degrees of success. They range from the mass extinction of community health information networks (CHINS) in the 1990s, to the ill-fated regional health information organizations (RHIOs) of the early 2000s, to today's more robust HIEs (also known as Health Information Organizations, or HIOs). These HIEs, which often span states and include thousands of providers, received $564 million under the 2009 federal stimulus law.
Both private and government-sponsored health information exchange organizations have tested their ability to use patient information to improve health care, lower costs and bolster medical research. But the increased emphasis on achieving those goals in order to get paid by Medicare and Medicaid now adds pressure on providers to share valuable data.
From 2010 to 2015, the number of HIEs fluctuated, but overall their numbers increased 41%, according to a federal government report.
The most successful exchanges are often located in rural markets as they can attract provider participants because they share the common dilemma of having sparse health IT infrastructure, according to a 2011 report from the Healthcare Information and Management Systems Society. Rural providers likely base their decision to participate on a “core value proposition” and are less likely to have competing health IT priorities.
This spring, a research report released by the Office of the National Coordinator for Health Information Technology at HHS found that the number of healthcare organizations exchanging clinical data, such as lab test results, radiology reports, clinical-care summaries and medication lists rose from 41% in 2008 to 62% in 2013. Surescripts, a private network, reported it handled 9.7 billion electronic transactions in 2015, up 48% over the year before.
But there have been many setbacks as well.
Seven of the recipients of the federal, state-wide HIE grants (in Connecticut, Illinois, Montana, Nevada, New Hampshire, Puerto Rico and Wyoming) went out of business after their federal funds ran out, according to another report on exchanges funded by the ONC and released in March.
The ambitious MetroChicago HIE that connected more than 30 northeastern Illinois hospitals went under earlier this year after its core technology vendor, Sandlot Solutions, of Fort Worth, Texas, abruptly went out of business in April while holding 2 million patient records.
The Illinois Hospital and Health Association stepped in and offered a secure messaging service to those affected members, but the full array of HIE services provided by Sandlot were not restored.
In California, two years after the second and third largest payers in the Golden State launched with fanfare Cal Index, a proposed state-wide health information exchange, Anthem Blue Cross and Blue Shield of California are still having trouble attracting provider HIE users.
In Missouri, Gov. Jay Nixon vetoed a section of a budget bill in May that would have funded health information exchange subsidies for long-term care providers and behavioral health centers. Nixon said the line would 'unfairly exempt select providers.'