What's next for health information exchanges?

With many community-based HIEs establishing sustainable business models, here’s a look at how the next generation of exchanges are starting to take shape.
By Tom Sullivan
01:56 PM
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HIE business models

Mission Hospital is part of SHIEC through St. Joseph Health network in California.

Health information exchanges have for years been plagued by the looming question: Is HIE as a business model actually sustainable? And while few argue that they have faced challenges to basic survival, experts are now saying that many HIEs have grown strong roots. Some are even thriving.

“HIEs are alive and well and we’re moving forward to support our communities,” said Dick Thompson, chairman of the Strategic Health Information Exchange Collaborative, which counts 55 HIEs as members. “The exchanges have begun to readily identify value and they are monetizing that value to sustain themselves.”

Health information exchanges are poised to become increasingly important as the Office of the National Coordinator for Health IT focuses even more on interoperability, as is mandated by the 21st Century Cures Act and as ONC head Donald Rucker, MD, has publicly said it will.

“There will be significant discussion about the role that HIEs play in furthering those goals,” said HIMSS Analytics executive vice president Blain Newton.

HIE momentum growing amid challenges

SHIEC’s Thompson said that the collaborative has seen a 67 percent spike in memberships since this time last year. He attributed that to HIEs establishing themselves as trusted data repositories, experts in connectivity and apt problem solvers in their communities. 

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That said, HIE is not a one-size-fits-all business model. Some of the success stories Thompson pointed to include serving Medicaid populations, alerting payers when members present at the emergency department, and aggregating patient data across hospitals, ambulatory care providers and specialists — tasks that those participants cannot easily access elsewhere.

That’s not to say HIEs have reached perfection. Far from it, instead, and Thompson acknowledged that they’re getting better one step at a time.

“The current feedback from providers indicates the need for HIEs to evolve as the market evolves as they leverage the appropriate data for different healthcare initiatives, such as population health and MACRA,” Newton added.  

HIMSS Analytics research, in fact, found that as of 2016 HIEs had not been widely implemented for population health. 

While HIMSS Analytics is continuing to investigate how providers will leverage exchanges for such initiatives moving forward, SHIEC’s Thompson said that many HIEs are well-positioned to support pop health efforts. Same goes for MACRA, behavioral health and social determinants, he added, work that is already starting in some organizations.

HIE 3.0 coming?

In January of 2013, Micky Tripathi, CEO of the Massachusetts eHealth Collaborative, declared that the industry had entered into a bold new world of health information exchange.

That would be HIE 2.0. The second generation is built on modern technologies, including cloud services, mHealth apps and IoT devices, inexpensive storage and broadband connectivity and adjusted market expectations wherein consumers and caregivers demand electronic access to their records, not to mention the ability to share that data among providers.

Thompson said that the next generation of exchanges, call it HIE 3.0, will harness that IT infrastructure to integrate social determinants and behavioral health into medical data within EHRs, and HIEs are best-positioned to accomplish that.

They will also be able to support information aggregations that combine clinical quality elements with payer data to help hospitals and insurers more effectively associate quality with cost and, in turn, to make that value more transparent to those buying and delivering care services. Thompson added that such work will then enable HIEs to understand and analyze the data they have in new ways.

“We’re on the frontier,” Thompson said. “HIE 3.0 will engage with patients. That takes a level of trust that is less about technology than it is about people and process and building networks of trust between individuals.” 

Twitter: SullyHIT
Email the writer: tom.sullivan@himssmedia.com