“We’re maturing from HIE 1.0 to HIE 2.0,” Micky Tripathi proclaimed. “We’re in a new world now.”

A raft of technologies including broadband, cloud computing, cheaper storage, and mobile devices, among others, is driving the transformation. At the same time, market expectations regarding standards of care are changing, as are younger providers’ relationship with health-specific IT. All those factors are also sparking the move toward decentralization and a bottom-up phenomena in which consumers begin asking for electronic access and for those records to be shared across providers.

Another “of the things that’s driving [HIE 2.0] is the limited success of the prior model,” Tripathi, CEO of the Massachusetts eHealth Collaborative and chairman of the ONC information exchange working group (IEWG) said during his "The State of HIE" keynote before a rare joint meeting of the HIT Policy and Standards committees January 29. “There have been pockets of deep success, but it hasn’t been uniform, and those have been real pockets of success with a lot of hard work to get them going.”

[See also: Physician approaches to HIE vary widely.]

Hudson River Valley

Perhaps more a large region than a small pocket of success, the Hudson River Valley in New York is home to HIXNY, an exchange brimming with a 94 percent affirmative consent rate that patient information be shared.

Based just outside New York’s capital city, Albany, and established in 1995, HIXNY is a mature HIE serving 23 hospitals in 16 counties, but the electronic exchange ramp-up has happened rapidly, according to CEO Mark McKinney.

[See also: Mostashari spotlights ROI in HIE.}

“We had one CCD document in October of 2011,” McKinney said. “In May of 2012 we had 250,00 and in July 325,000.” As of February 2013, more than 1.4 million CCDs have been pushed to HIXNY’s HIE, which boasts a Master Patient Index 2.3 million records strong.

It would appear that at HIXNY such exchange momentum begets momentum. And even the stalwart HIE is looking ahead to the next phase of exchange.

“We’ve shown physicians the future, to some extent, and now that they see the potential they want more,” said Kallanna Manjunath, MD, CPE (pictured at left) and the chief medical officer at Whitney M. Young Jr., Health Centers, an Albany, NY-based community hospital and a HIXNY participant.

To that end, prospective physicians and patients are asking Manjunath questions along the lines of: Why aren’t I getting the discharge information, the hospital consult? Why are the specialists not joining? They just want our data but why are they are not sharing?