HIEs coming of age and proving their worth

The wobbly credibility of third-party health information exchange organizations got a boost last week after Texas Health Resources signed up to share patient data in a highly competitive healthcare market.

The 14-hospital system will join 32 other providers that are part of Healthcare Access San Antonio, which stretches from the Oklahoma border on the north down to Corpus Christi on the Gulf Coast. The exchange handles nearly 2.2 million patient records and supports about 2,400 HIE users. It's one of nine HIEs in Texas and about 150 nationwide.

For decades, exchanges have gone by various names, been run privately and by government agencies, and have had varying degrees of success. The most recent incarnation, HIEs, received $564 million under the 2009 federal stimulus law with the goal of using patient information to improve healthcare, 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.

This spring, a research report released by HHS' Office of the National Coordinator for Health Information Technology 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, handled

9.7 billion electronic transactions in 2015, up 48% from the prior year.

There have, however, been many setbacks as well.

Seven of the recipients of the federal, statewide HIE grants (in Connecticut, Illinois, Montana, Nevada, New Hampshire, Puerto Rico and Wyoming) went belly up after their federal funds ran out.

MetroChicago HIE, which connected more than 30 northeastern Illinois hospitals, ended

In California, two years after the state's second- and third-largest payers launched Cal Index with fanfare, Anthem Blue Cross and Blue Shield of California are still having trouble attracting provider HIE users to the statewide health information exchange.

This spring in Missouri, Gov. Jay Nixon vetoed a section of a budget bill that would have funded health information exchange subsidies for long-term care providers and behavioral health centers. Nixon said the line item would “unfairly exempt select providers.”

In north Texas, Healthcare Access San Antonio was asked to take over HIE duties from North Texas Accountable Healthcare Partnership after the 6-year-old group relinquished those chores to gain economies of scale.

“We had signed the paperwork and were literally one week away to go-live” with the exchange, when its sponsors decided to “go in another direction,” said Joey Sudomir, vice president and chief information officer at Texas Health Resources. But the switch went smoothly, and his system is already fully operational on the new exchange, he said.

Despite those bumps, HIEs are lowering providers' costs of information exchange, said Jim Hoag, market lead at Healthcare Access San Antonio in north Texas. Most of the hospitals in the Dallas-Fort Worth area have either adopted or plan to use the same electronic health record system from Epic Systems Corp., Hoag said, so they can send and receive clinical messages using Epic's built-in information exchange software.

Before joining the HIE, Texas Health Resources had been exchanging information with other hospitals through its EHR, but Sudomir agreed: “It's beneficial to have a wide palette of options” that the HIE offers.

No one was looking to make money on the investment in an HIE, Sudomir said. “It's a pure community benefit play,” he said. “There is no financial ROI (return on investment) on this, and we've never been asked by our leadership to prove an ROI. We just feel it's better for our patients for clinicians to have every bit of clinical information at their fingertips.”

The real challenge going forward for HIEs will be to adapt the technology to future market demands.

The San Antonio HIE is building the technology physicians will need to generate reports under the Merit-based Incentive Payment System of the Medicare Access and CHIP Reauthorization Act, Hoag said.

“A central patient record (makes it) a lot easier and less expensive for those doctors to create that MACRA reporting,” he said.

As Sudomir puts it, “It's all about having the right information at the right time to make well-informed clinical decisions for the patient.”