Annual eHI Survey Finds RHIO Progress but with Caveats

Digital HealthCare & Productivity | Financial sustainability remains the greatest barrier to interorganizational health information exchange, but private entities are starting to play a greater role in getting exchanges off the ground, according to a new survey.

In its Fourth Annual Survey of Health Information Exchange at the State, Regional and Community Levels, released last week, the Washington-based eHealth Initiative (eHI) reports that at least 32 community exchanges were “operational” in 2007, up from 26 a year ago, but representing only one quarter of the 130 initiatives surveyed.

Of those designated as operational, meaning that they are actively exchanging data, 84 percent report that they are sharing information related to outpatient episodes and 64 percent are exchanging inpatient data. Those figures represent 32 percent and 28 percent of the entire survey pool, respectively, compared to 21 percent and 23 percent in 2006.

Data exchange also increased for laboratory and radiology results, emergency care, and outpatient prescriptions, but was nearly stagnant at 27 percent for enrollment and eligibility checking.

Those numbers were slightly below figures cited in a Dec. 11 report in the journal Health Affairs, which tracked the progress of regional health information exchanges (RHIOs). 

In 2005, eHI defined health information exchange as the “mobilization of healthcare information electronically across organizations within a region or community,” and RHIOs engage in such activities. eHI chief executive Janet Marchibroda says that her organization is interested in data mobilization, no matter how that is accomplished, and is not favoring one approach over another.

Five of the exchanges in the eHI survey are “no longer moving forward,” while the Health Affairs paper identified 36 RHIOs as defunct. “I was pleased to see that every organization that was stage 5 or higher last year—operational—is still operating this year,” Marchibroda says of the eHI findings.

Still, finding a sustainable business model remains elusive. More than half of the respondents to the eHI survey called this a “very difficult challenge.” Other tough issues include securing start-up funding, defining value for users, and dealing with privacy and security concerns.

Significantly, more upfront funding is coming from private sources; 53 percent of those surveyed say they received start-up capital from hospitals and 32 percent received money from private payers—both more than double last year’s rates. Some 44 percent were the beneficiaries of federal grants and contracts, while 43 received state funding to get off the ground.

“The fact that we’re seeing the private sector stepping up, that’s not surprising,” Marchibroda says. This shows that hospitals and payers are starting seeing the benefits of information sharing, both financially and in terms of patient outcomes.

“I think the real key here is creating near-term successes to make the case for actions that could provide long-term sustainability,” Marchibroda says. In the short term, health information exchanges are proving their usefulness for performance measurement, drug safety, and disease management, eHI found.

However, Marchibroda says it is important for government entities to continue to provide seed money as long as the reimbursement system rewards volume rather than quality. “We’ve got to tackle the long-term payment issues that act as disincentives to sharing data,” the eHI chief says.

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