Health information exchange efforts increase, but funding challenges remain

By Caroline Broder
12:00 AM

Health information exchange networks designed to stem rising healthcare costs and reduce inefficiencies are on the rise, but funding for such networks remains elusive, a survey released today from the eHealth Initiative found.

The survey of 109 state, regional and community-based health information exchange initiatives asked respondents to identify their stage of development in exchanging healthcare data across a spectrum of the industry – from physicians' offices and hospitals to laboratories and health insurers.

Sixty-five respondents said they were in the advanced stage of development, meaning they were addressing the technical, legal and financial issues needed to exchange data. Of those, 25 said they were "fully operational" and were exchanging data. A similar survey conducted last year found that only nine health information exchanges identified as fully operational. Forty-four respondents in this year's survey said they were still within the early stages of development, meaning they were still seeking funding and deciding on the network's governance structure.

The survey also suggests that these networks are maturing, involving providers, healthcare purchasers and payers in their governance structure. However, providers are still the major players in these efforts, with 61 percent involving hospitals in the key role. Fifty-five percent of all respondents said their health information initiatives are led by a multi-stakeholder organization.

"We were pleasantly surprised to see how far along these groups are. They are solid, multi-stakeholder groups that are collaborative," said Jennifer Covich Bordenick, vice president of the Foundation for eHealth Initiative, which conducted the study.

More than one-third of advanced stage projects are currently providing services such as enrollment or eligibility checking, a repository of clinical results, clinical documentation and delivery of clinical results, among other services. However, most of these networks are not supporting patient-physician communication, with only 3 percent of early stage efforts and 6 to 12 percent of advanced stage initiatives providing any type of patient-provider communication.

Most of the advanced-stage networks are exchanging information related to outpatient and inpatient care, emergency department episodes, laboratory data, enrollment and eligibility data and pathology results. In addition, more than half of the networks that are exchanging information electronically go beyond federal HIPAA requirements to protect patient data and these networks are increasingly using healthcare data standards to transmit information.

However, funding issues and accurately linking patient data remain the two biggest challenges to these networks. Many of these networks still rely on government funds, a model that isn't sustainable in the long run, according to Covich Bordenick. Forty-six percent of all respondents use federal funds to support upfront development costs.

However, some of the more advanced networks are moving toward a financial model that relies on advance payments from hospitals, physician practices, public health agencies, labs, payers and purchasers.

Mark Frisse, MD, argues that there is enough money in the healthcare system to support these networks, but that healthcare dollars aren't being allocated toward these efforts.

"There is plenty of money in the healthcare system. It's the way the money is being spent," said Frisse, who leads a state effort in Tennessee to create a regional health information exchange and serves as co-chair for eHI's Working Group for Connecting Communities.

David Clark, director of integration and interoperability for the Healthcare Information and Management Systems Society, said there has been rapid growth of community efforts to exchange healthcare data, but that it could take another decade before these networks are ubiquitous.

"The technology is there," Clark said. "The challenge is the business relationships, agreeing on standards and identifying funding sources."

The eHealth Initiative Foundation conducted the survey with support from HHS' Health Resources and Services Administration Office of the Advancement of Telehealth.