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What is Behind the Heated Debate Regarding the Success of HIE?

April 17, 2014
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For the upcoming April/May issue of Healthcare Informatics, I have written a feature story on the state of health information exchange (HIE) across the country. While some health IT leaders feel that HIE has been flourishing and those who have thrived are setting the pace for those who are a little behind, others think the successful HIE organizations are few and far between, and that successful exchange of health information has become too much of a struggle.

What these leaders don’t seem to argue about is that HIE is in an early-adopter phase with an uncertain future. Recent reports say that the global HIE market is projected to reach $878 million in 2018, growing at a compound annual growth rate (CAGR) of 9.5 percent from 2013. This is due to factors such as incentives by the U.S. federal government, improvements in patient care and safety, and reduction in healthcare costs. However, issues such as high implementation costs, slow returns on investment, and interoperability problems are hampering the growth of this market.

For my story, Micky Tripathi, Ph.D., CEO of the Massachusetts eHealth Collaborative (MAeHC), told me that technology has enabled people to do HIE in many different ways, and because of that, supply is responding. “It’s hard for me to run across a hospital or hospital system that doesn’t have some sort of HIE plan,” he said.

But other health IT leaders—such as Sumit Nagpal, CEO of Alere Accountable Care Solutions (ACS), a Waltham, Mass.-based vendor with an HIE solution—feel that the number of places where HIE is truly working is not high; “There are still only a handful of success stories (in the tens, not the hundreds or thousands), simply because it’s an early adopter market,” Nagpal said. Nagpal feels this is a result of vendors still not buying into opening up their silos and making data available for everything that it’s needed for, because they haven’t figured out what they will be giving up by making that happen. And the provider organizations are wrestling with the same real considerations—what advantages are they giving up that they worked so hard for to create?

But what is it that is accounting for such a divide amongst industry professionals? How could people’s opinions about HIE differ so greatly? I think one reason for the disconnect is because health IT execs are taking a firm wait-and-see approach. They want to see the larger organizations do it first, and then monitor what that might mean for their own organization. Nagpal pretty much confirmed this thought in our interview, calling the HIE market one for early adopters—so when you look at the bell curve, it’s still in the early stages of the upward swing. There are many organizations trying to figure out what to do and how to respond, and in general, people are going to wait to see the results before jumping in, he said. In this sense, it’s like any other industry, where the early pioneers pay a heavier cost to achieve the goals, but then they benefit from being first. Because of this, it would make sense why people have differing opinions about how well HIE is doing—those organizations who aren’t actively engaged in it might not have the most accurate idea on its success or lack of.  

Another reason for the difference in opinion might have to do with lofty expectations of many in the industry. There is certainly an impression among many that interoperability has been a failure up until now. But according to Tripathi, that is because there was once a sense there would be a nationwide physician health information network, and there would be sub-networks and a common set of rules. “Those expectations have been had for many years,” he said, adding that there are HIE organizations that were also a part of that vision with the idea of bringing the data together and normalizing it with a particular paradigm for what health information exchange is—but the reality now is that what is happening is what we have seen in other industries—it’s very tactical, solving very immediate problems, and it’s market based, he said.

That process can certainly be quite frustrating for providers who want immediate success from the technology they are using. But often with health information exchanges, you solve a problem, wait to see what happens, and then go from there for the next problem. Tripathi compared it to when email or phone systems were first developed, as it took a long time to get to the maturity to get to where they are now. Indeed, there are progressions that we all have to go through when it comes to any new technology, and perhaps the same will hold true for HIE. And for those who had high expectations which have not yet been met, perhaps that frustration is coming out in their opinions.

At the end of the day, there are plenty of reasons to be frustrated with the challenges that HIE comes with right now, as everyone is looking for faster, better, and cheaper connectivity. And according to some, it might even get messier before it gets cleaner. But for the healthcare industry, I truly do believe that HIE will be a necessity for both provider organizations and the patients they are caring for in the not-so-distant future. A complete view of patient data—across the care continuum—is now becoming a real prerequisite for better clinical outcomes. After all, in today’s world of interoperability, what good is data if it is in a vacuum? So even though there seems to be a disconnect today on whether or not HIE is flourishing, one thing we hopefully can all agree on is the need to get it right as the industry continues to move in the direction of population health management and risk-based care.