Technology challenges have some blame for the sorry state of health data exchange in the U.S., but it's also a matter of simple dollars and cents.

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Niam Yaraghi, a fellow in the Brookings Institution's Center for Technology Innovation, has authored a new study in which he posits that economic disincentives – much more so than poor interoperability – are to blame for the fact that health information exchange hasn't yet caught on in the real and sustainable way it needs to.

In his Brookings paper, "A Sustainable Business Model for Health Information Exchange Platforms: The Solution to Interoperability in Healthcare IT," Yaraghi makes the case that better aligning economic incentives will spur the varied stakeholders across the care continuum – patients, providers, payers, medical data and providers – to more actively share health data.

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He points to an evolved business landscape in which more HIE platforms generate revenue – by offering real-time data services for providers, as well as self-developed analytics tools and customized reports.

Money from these sources could sustainably finance the operational costs the HIE, he says, leading to self-sufficiency and sustainability are furthermore as federal and state support dries up.

Some state HIEs are already embracing strategies such as these, of course, such as Maine's HealthInfoNet, which has recently begun offering near-real-time data to help providers and ACOs with predictive analytics.

"We believe this type of service is an important piece of the sustainability pie for the HIE and its customers," said HealthInfoNet CEO Devore Culver.

"While I admire the efforts to address interoperability as a technical problem, I argue that it is more of an economic and political rather than a technical issue," writes Yaraghi.

In the wake of the ambitious draft roadmap put forth this past week by the Office of the National Coordinator for Health IT, long-term interoperability still depends on ensuring the right incentives are in place, he says.

"As long as the long-term economic benefits of all of the medical providers are not adequately addressed, neither the development of new IT standards, nor allocating more financial incentives would drive them to effectively engage in the electronic exchange of medical information," Yaraghi writes.

Read his report here.