Contributed by John Kansky, HIMSS Fellow

Communities small and large are in a quandary about where to begin to accomplish health information exchange (HIE). And with a multitude of issues to overcome, like limited financial resources, politics and even human nature, it is important to make wise choices.  
For example, a community might begin with the questions, “What information and functionality is needed to improve patient safety and quality of care, and how can this be achieved?”  
While these issues are at the heart of health information exchange, there is an additional consideration that cannot be ignored:  “What value will the exchange of information create, and who will be willing to pay for this value now and in the future?”
One way to think about the value of health information exchange is to consider a business decision made by the fast food restaurant industry.
Prior to the 1980s, fast food restaurants didn’t serve breakfast.  What changed this business decision?  Companies realized they could use the same infrastructure, employees and processes to create something people wanted and would be willing to pay for.  
The same thing is seen with health information exchange. Once a community has invested in the hard costs and built the necessary “political capital” to begin exchanging data, the same data, interfaces and established physician relationships can be used to create additional value.  
In Indiana, for example, our foundation is a messaging service that delivers clinical reports (including labs, transcription and radiology) to physicians electronically. It was a way to engage our hospital systems, clinicians and other stakeholders and deliver information and operational value. Immediately, our customers saw how it impacted the bottom line while improving patient care. Upon that sustainable foundation, we are adding – like layers – information services that have value.
Once a foundational service like this is in place, communities can begin to expand the types of data provided. Two such opportunities are medication history information and quality reporting services. Both of these examples build on existing infrastructures and have a value proposition that is clear for a number of stakeholders, including healthcare and insurance providers.  
For medication history, let’s use the specific example of medication reconciliation in the inpatient setting, where a patient’s current medication list must be documented and compared against a physician’s admission, transfer and/or discharge orders. For most hospitals, this is a highly manual process.
Medication history information gathered from multiple sources can provide a reliable starting point to accelerate the medication reconciliation process, potentially saving money in employee costs while positively impacting patient safety.  
Quality reporting, an important but often problematic issue, is another example of how HIEs can provide value. It can perform the analysis and reporting of information to providers and payers to enable a fair and accurate quality program. Additional value from the HIE could include standardized measures used by both physicians and health insurers, alerts, reminders and follow-up treatment information.
A recent eHealth Initiative Foundation study that evaluated a handful of thriving HIEs revealed that sustainable HIEs are possible, but there is no “one size fits all” solution.  Keeping in mind the questions above, it is important to start with a small, solid foundation – one that creates immediate value and relevancy in day-to-day operations. Building the infrastructure necessary for a health information exchange based on one “value vehicle” is potentially a recipe for failure.

John Kansky is vice president of business development for the Indiana Health Information Exchange.  He has worked in the healthcare technology field for 20 years, with experience in healthcare information technology, biomedical technology and IT strategic planning.