Beyond the big headline that the total number of live health information exchanges (HIEs) more than doubled in the past year, the recent study from the Orem, Utah-based KLAS Research showed a lag in adoption due to many reasons including physician reticence, governance, and funding issues.
Among the live HIEs that KLAS validated, only 43 percent are delivering patient data directly into physicians’ electronic medical records (EMRs). “I’ve spoken to providers and they say, ‘if our folks have to go one to two extra steps out of natural workflow, they’re not going to do it,’” says Mark Allphin, senior research director and lead author of the report. “What it comes down to is how we can get it in the natural workflow of the physician.”
Clinicians report interest in HIEs, but not if it causes them to lose time searching for or wading through too much patient information, the report states. Allphin adds that incorporating data from the HIE into physicians’ EHR is “top of mind” for both providers and vendors and is cited most often as a key indicator of HIE success. Most vendors, he says, accommodate both a portal view of patient information and a direct interface with the EMR.
Other hindrances to HIE adoption are concerns with data integrity and having outside providers push data into physician's EMRs. “Physicians are really nervous about what data makes it in to their personal medical record,” Allphin says. He suggests that HIEs should “tread lightly” when building interfaces and work closely with physicians from the beginning to make sure the right information is displayed and to get continual feedback.
Public HIE Challenges: Governance, Funding
Since 2010 the number of live public HIEs rose from 37 last year to just 67 this year, while the number of live private HIEs more than tripled from 52 last year to 161 this year, according to the report. Two factors, governance and funding, were cited by the report as contributing to the slow growth of public HIEs.
The report states that inherent in government-sponsored HIEs and initiatives involving competing healthcare organizations are complications with getting complete stakeholder buy-in, whereas private HIEs can be more nimble since they do not rely entirely on public funds or government oversight.
“Oftentimes it isn’t a technical issue,” says Allphin. “It is a political issue with making sure all parties at the table at different organizations and IDNs [independent delivery networks] agree upon how this information is going to be exchanged, what information is going to be exchanged, what time the information is going to be exchanged, and who’s going to pay for it—all of that got brought up over and over again.”
Another barrier for adoption respondents brought up is the high cost of information exchange. Of the public HIEs interviewed, 54 percent express concern about future funding, while only 35 percent of private HIEs have the same worry. Those interviewed from public HIEs worry about economic and political upheavals that may cause grants and funding to dry up at any time, leaving them without the means to continue functioning.
In addition to basic infrastructure costs, HIEs are additionally having a hard time absorbing the cost of interfacing providers’ EMRs with the HIE. “We spoke with several sites that mentioned [it would cost] over $10,000 for a single interface to be built,” says Allphin. “Well, a lot of practices can’t afford that.” He adds that one state HIE he spoke with did have additional funding to offer providers, a $2,500 grant for interfaces, but that only covered a fraction of the total cost of interfacing.
“What I heard from both the public and the private HIEs at the end of the day was that the exchange still has to provide real value to those using it because that will ensure long-term sustainability,” concludes Allphin. “It’s one thing to have access to that information, but it’s another to do something with that information and what additional analysis you can provide.”
For more on KLAS' health information exchange report, listen to the Healthcare Informatics Podcast with Mark Allphin.