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Black Book Research: Meaningful Interoperability Remains Years Away

February 17, 2015
by Rajiv Leventhal
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Ninety-four percent of stakeholders are “meaningfully unconnected,” according to the survey’s results

The current state of operative health information exchanges (HIEs) in the U.S. can best be described as “persistent unpredictability,” and the industry appears a ways away from achieving meaningful interoperability, according to Black Book Research’s annual HIE stakeholder survey.

While new federal grants aim to resuscitate failing state and regional public HIEs, a growing number of IT vendors are drastically cutting further interoperability research and development funding, according to the survey, which polled nearly 2,000 health plan members/patients, 800 independent and employed physicians, 700 hospital executives, 1,200 insurers, and 500 health IT vendor staffers.

Some simple healthcare information is being exchanged among parallel electronic health record (EHR) systems in pockets of communities but Black Book reports that 94 percent of America’s providers, healthcare agencies, patients and payers persist as meaningfully unconnected in Q1 2015. Outside of their garden walled EHR networks, providers are dropping HIE as a priority, as evidenced by a 5 percent drop in regional connectivity from last year.

The survey shows that providers are retreating from complex HIE endeavors, due, in part, to the flawed business models of public HIES and the waiting game to see if payers foot the bill for significant data sharing mechanisms, according to 90 percent of hospital organizations and 94 percent of independent physicians.

“Although the Office of the National Coordinator for Health IT recently released a draft detailing a ten-year nationwide interoperability road map for basic health record connectivity by 2017, fewer and more specifically defined interoperability objectives are needed to focus stakeholders to prevent the technology industry from backing further away from connectivity initiatives,” Doug Brown, managing partner of Black Book Research, said in a news release accompanying the survey’s results.

What’s more, stakeholders forecast the evolution and expansion of payer-owned and private network vendors and the contraction of the public HIE vendor market. “A short list of enterprise HIE vendors have effectively established operative exchanges across organizational siloes to benefit patients, providers, agencies and payers,” said Brown. “Those vendors are justifiably earning the lion’s share of 2015 initiatives and stymied HIE developers are reconsidering their positions.”

Further, 72 percent of HIE stakeholders predict the demise of most small, independent HIE developers by 2017, particularly those that have not proven operative to the government payer and commercial insurance sectors, and those HIEs not owned or acquired by the major insurers by then, according to survey results.

In 2014, 70 percent of surveyed health insurers rejected participation in public HIEs. Trust has surged in payer-owned HIEs as well as in data sharing networks developed by HIE vendors for payer groups following a year of resolving data ownership and accountability issues, according to 86 percent of provider respondents, up from 40 percent in 2013.

Additionally, 90 percent of providers and 98 percent of payers agree that payers will fill an information gap for clinicians at the point of eligibility, and will allow them to administer better care via access to aggregated data on members, according to survey results. "Providers are simply not benefiting financially yet from HIE development. Without proven worth or certain return, the shift to payer investment in private HIEs was inevitable with value-based care emerging", said Brown.

“As risk sharing increases, so will the demand for meaningful, robust data sharing between providers and payers regardless of the EHR employed. “ Brown added. “If the interfaces for interoperability between the HIE and stakeholders is too difficult to evaluate and analyze risk, the more likely we will see another round of EHR replacements.”

In an adjunct HIE user survey, surveyors polled users of 224 operational exchanges, both public and private, to determine the top performing vendors on twenty HIE-specific gages. Current users ranked four HIE vendors as top performers in their specialty theatres of engagement. Ranking first in their respective categories in the interoperability marketplace for 2014 are:

  • Cerner –EHR/HIT-based HIE
  • Orion Health– government payer and commercial insurer centric HIEs
  • Aetna Medicity – core private enterprise HIE solutions
  • Intersystems –core public HIEs systems


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