OREM, UT – Vendors may suggest that many successful health information exchanges have been built with their technology, but the reality is different, according to a new report from KLAS.

A small number of vendors – with Axolotl among the top – have risen to the challenge enough times to claim a proven, repeatable model, the Orem, Utah-based research firm found.

In "Health Information Exchanges: The Reality of HIE Adoption," KLAS validated 89 live HIE organizations that use commercial technologies to share patient data that is viewed by doctors. The HIEs included in the study had to be exchanging data among facilities that are not owned by the same organization.

Software vendor Axolotl has the most live HIE clients in the acute-to-acute space, where two or more hospitals or health systems are sharing patient data, with seven organizations. Providers cited the San Jose, Calif.-based company's flexible technology and staff expertise with the HIE process as key reasons for selecting Axolotl.

Epic also had seven validated acute-to-acute sites, KLAS said, but is considered a unique case in that its Care Everywhere solution currently only connects Epic software customers.

Among acute-to-ambulatory HIEs, where at least one hospital or health system is sharing data with a clinic, lab or other ambulatory facility, Medicity's Novo Grid was the leader with 22 live sites. According to providers, the Novo Grid solution is simple but effective, typically funneling lab results from hospital labs and reference labs to ambulatory sites. RelayHealth also had a relatively strong showing in the acute-to-ambulatory space, with eight validated live HIE organizations using its technology.

In total, the KLAS report highlights the commercial HIE solutions of 22 vendors, most of which have one to three validated sites.

"It's no great surprise that, so far, the most successful HIEs are those with the least complex approaches," said Jason Hess, KLAS' general manager of clinical research and author of the HIE report. "The eclectic way that clinical information is structured, stored, labeled and shipped makes it very difficult for vendors to connect all of the discreet data elements. In the majority of cases, HIE vendors are opting to pass around packets of information without necessarily taking ownership of what is in the packet.

"However, that approach does create some manual intervention with almost every transaction, whether clicking on an icon to see the data, going into a portal to look at it, or opening a separate folder on a PC, especially for a physician without an EMR," Hess said.

Beyond the technology, providers also reported a number of administrative challenges they encountered in deploying an HIE. Topping that list were IT governance concerns regarding privacy, security and patient consent, as well as the financial viability and sustainability of the HIE. In fact, when it comes to financing an HIE, KLAS found that among its 89 validated sites, more than 70 percent are funded with state or federal grants.