eHI survey: HIE landscape in transition
Although 2010 saw some consolidation among health information exchanges (HIEs), this has been a year of expansion for HIE in general, according to the 2011 eHealth Initiative’s annual survey. The annual survey identified 255 active HIEs across the nation and its territories. Of those, 196 responded to the 2011 survey, said Genevieve Morris, eHealth Initiative’s manager of research and programs for HIEs, during a web presentation last week.

Of that total, 85 are considered advanced initiatives according to eHI’s criteria (active exchanges, providing advanced services). Fifty-four respondents indicated they are not dependent on federal funding, and 24 said they were sustainable—meaning they weren’t dependent on federal funding and broke even on operational revenue—up from 18 last year, Morris said.

While 10 HIEs joined forces with others or ceased operations, 46 new respondents answered the survey in 2011, for a net growth of 9 percent.

More advanced HIE initiatives are offering value-added services such as analytics, quality reporting and PACS reporting, she said. These advanced HIEs are also more likely to receive revenues from more than one source, and three key stakeholder groups include multiple revenue sources (membership fees, state funds and fees for services), with membership fees the most utilized, the survey showed. A number of HIE initiatives don’t charge providers to participate, but no initiative has done a cost-saving revenue-sharing model, she said.

Developing a sustainable business model is still the top challenge, and defining value for stakeholders has moved up the list. “One big change we saw was that systems integration is more of a concern than in the past.”

HIEs are developing complex privacy controls even in the absence of new federal requirements. More HIEs are taking a granular approach to patient data privacy, and provide opt-in or opt-out by data type (such as lab reports and radiology results) or by data field (such as demographic information). “In years past, most initiatives offered [a global approach to privacy], so we were impressed to see most organizations offering a much more detailed level of choice, which helps build the trust framework with patients,” Morris said.

A majority of advanced initiatives are offering at least one service that supports MU requirements for Stage 1 and some proposed Stage 2 requirements, she said. The survey showed a big jump in connectivity to EHRs among HIEs (from 49 in 2010 to 60 in 2011). Eighteen respondents are now accommodating image exchange (new in the 2011 survey), and 47 support results delivery.

Also notable was a large increase in the number of HIEs that reported behavioral/mental health providers were offering and viewing data, from 10 last year to 18 in 2011. The number of mental health providers viewing and receiving data also rose, from 27 last year to 32 this year, Morris said.

Nearly one-quarter of respondents said they will support an accountable care organization (ACO), perhaps recognizing that ACOs will need a lot of care coordination and represent an HIE opportunity. “You need to have a way to pull that data together. It looks like HIEs are getting ready to support [ACOs] so they can pull all of the data for a patient together for best care coordination in the ACO model,” she said.

Among non-clinical value-add services, aggregation of administrative transactions spiked highest, from three HIEs offering it last year to 23 in 2011. Likewise, billing services, offered by six initiatives last year, are now on the menu of 22 HIEs. Credentialing services are offered by 18 now, up from three last year.

The level of support for the Nationwide Health Information Network (NwHIN) is also on the rise: 113 initiatives plan to incorporate the NwHIN Direct Project into their service offerings, according to the survey. The top use cases for Direct include transitions of care (clinical summaries), which aligns with Stage 1 requirements. Exchange of lab results, sending information to patients’ PHRs and public health reporting were also listed.

“This past year has been transformational. It seems like the market is shifting,” Morris concluded. “With the shift from the ‘noun HIE’ to the ‘verb HIE,’ with use cases, there’s going to be a lot of competition between private and community HIEs…. As an initiative, you have to start innovating and get to value-add services faster to be sustainable.”