The eHealth Initiative's annual survey of health information exchange shows that as HIE adoption expands, initiatives are facing growing pains such as competing timelines to meet federal requirements, complex systems integration and uncertainties around accountable care organizations.

The eHI 2011 Report on Health Information Exchange: The Changing Landscape documents 255 HIE initiatives, which are demonstrating an unprecedented amount of patient health information exchanged between physician offices, laboratories and hospitals across the nation.

“Some exchanges have solved their technical issues and are offering more advanced services, such as analytics, quality reporting, wellness programs and education to providers and hospitals," said eHealth Iniative CEO Jennifer Covich Bordenick. "As a result, they are in a much stronger position than those that have not expanded services. HIE initiatives that cannot adapt quickly may not last long in a transformed healthcare system."

She added that, "the HIE marketplace is very competitive today, but the momentum seems to be with private sector HIEs."

Key findings from the 2011 survey:

• There has been net growth of 9 percent in the number of initiatives, which total 255 in 2011. At least 10 HIE initiatives have closed or consolidated, and 46 new initiatives responded to the survey. Twenty-four initiatives report that they have sustainable business models, up from 18 in 2010.
• Initiatives are developing complex privacy controls for patients, even in the absence of new federal requirements.
• An increased number of behavioral or mental health providers report providing and viewing more data through exchanges.
• Despite uncertainty about accountable care organizations (ACOs), a quarter of the respondents indicated that they will support an ACO.
• In addition to struggling with business models and value, groups are facing new challenges related to technical aspects and systems integration.
• A majority of initiatives (113) plan to incorporate the federal Nationwide Health Information Network’s (NwHIN) Direct Project into their service offerings.
• The majority of advanced initiatives (85) are offering at least one service that supports meaningful use requirements.

“The number of initiatives offering services that improve patient care has increased in 2011," said Covich Bordenick. "As more HIE initiatives provide services such as e-prescribing, alerts to providers on drug interactions, clinical decision support, and medication reconciliation, the quality of care for patients will improve. When providers have access to vital patient information and consequently receive important alerts, patients benefit.”

As HIEs continue to move forward, eHI made the following recommendations:

• HIEs must move quickly to help providers with meaningful use, Medicare Shared Savings Program rules and privacy recommendations. Hesitancy about moving forward until changes to the healthcare system are complete will only diminish growth.
• Privacy will continue to be an important issue for patients. If patients are to be engaged in their care, they have to trust that their information can be securely exchanged. One way of many to build this trust framework: initiatives can offer patients more than a global consent model.
• Groups need to “work with what they have.” Since initiatives need to rapidly innovate and move through the stages of development quickly, they need to consider working with the existing infrastructure in their geography. Where there are well-developed IDNs or health systems, the community-based or state initiatives should try to work with them. While competition can be good for innovation, in the current rapidly changing healthcare market, competition may not be the best option for sustainability.