The National eHealth Collaborative (NeHC) Health Information Exchange (HIE) Learning Network has presented a set of suggested solutions to challenging HIE issues at the inaugural Technology Crossroads Conference, held in Washington, D.C., this week. These recommendations are the culmination of five months of work by a group of over 450 stakeholders. A detailed report by each workgroup on its findings is expected to be released the week of Dec. 3, in conjunction with a webinar to discuss the results of their work.

Financial Sustainability

The Business Models for Financial Sustainability workgroup conducted an in-depth study of the financial performance of HIE initiatives to identify and recommend strategies that can lead to financial sustainability. The workgroup gathered detailed financial information from HIE initiatives serving 38 million people, produced an income statement representing the current financial position of the HIE community and compared a group of HIE initiatives that are currently profitable to those that are currently unprofitable. The average profitable HIE realized a higher revenue from operations per capita due to a more aggressive pricing strategy, greater market share/penetration, and higher investment in product development.  The workgroup defined the magnitude of the “sustainability gap” and develop recommendations for how to address it.

“We read and hear frequently that HIEs lack a sustainable business model and are failing.  The Sustainability workgroup collected and analyzed HIE financial information and can state with confidence that it is premature to conclude that health information exchange is ultimately doomed.  Based on this groundbreaking work, we know the level of revenue and investment at which HIE sustainability should be achievable.  Further, it is clear that some HIEs are progressing toward sustainability,” says Jeff Rose, Venture Partner, ICG Group, Inc. and Co-Chair, NeHC HIE Learning Network workgroup on Business Models for Financial Sustainability.

Interoperability Standards

Achieving interoperability between inter-related software systems in a way that does not require steep technical interface costs is also a major challenge.  The NeHC HIE Learning Network workgroup on Addressing Variations in Implementation of Interoperability Standards reviewed current interoperability efforts, identified gaps, and recommends that the industry come together to develop consensus on a method for defining and measuring interoperability.  The key conclusion was that doing so would ultimately lead to better coordinated efforts and accelerated progress in reaching the ideal state of interoperability.

“With the increased focus on HIE in Meaningful Use Stage 2 and potentially more in Stage 3, and an ever-increasing need to ‘do more with less,’ it is time to determine whether the standards and tools we have developed thus far are actually meeting interoperability objectives. There is much work being done in this area, but as an industry, we have yet to measure progress.  If we do not start to measure, how will we know that we are truly moving forward in making a difference for our patients and providers?” notes Richard Wang, Director, Product Marketing, RelayHealth and Co-Chair, NeHC HIE Learning Network workgroup on Addressing Variations in Implementation of Interoperability Standards.

Prioritizing and Implementation

The NeHC HIE Learning Network workgroup on Best Practices for Prioritizing and Phasing Implementation of HIE Services worked to identify options for how HIEs should prioritize and phase implementation of technology infrastructure and exchange services. The workgroup recommends that HIE organizations first clearly understand the needs of their community and consider whether a comprehensive set of HIE services is required. In communities that need a full set of HIE services, the workgroup recommends implementing a series of high value bundles of services built on the lightest possible technology infrastructure. In communities that may not need comprehensive services, the workgroup recommends possible niche strategies that fulfill a specific need, such as offering HIE services to support meaningful use, respond to a specific government or market requirement such as Social Security disability determinations or Veterans Administration benefits determinations, or support transitions of care.

“Depending on the needs of community stakeholders, HIE initiatives can do a lot or a little.  But regardless of the strategy that best serves the community, offering high value, low cost services is critical to success.  The recommendations of the workgroup on Prioritizing and Phasing Implementation of HIE Services are on point with WHIE’s philosophy to start simple, demonstrate value and then move forward,” says Kim Pemble, Executive Director, Wisconsin HIE (WHIE) and Co-Chair, NeHC HIE Learning Network workgroup on Best Practices for Prioritizing and Phasing Implementation of HIE Services.

New Payment and Delivery Models

Economic pressures, health reform, and a healthcare system that is transitioning from “pay for volume” to “pay for value” are driving the establishment of new payment and delivery models and HIE will be a critical foundation of these new models. The NeHC HIE Learning Network workgroup on HIE Functions to Support New Payment and Delivery Models recommends that in addition to providing basic, but critical, care coordination services (e.g., results delivery, continuity of care summaries, immunization reporting), HIEs should be prepared to provide analytic tools, including business intelligence and comparative analytics, and to develop the infrastructure necessary to perform quality reporting and referral processing. The workgroup has also outlined a set of characteristics and actions that are necessary for HIEs seeking to support new models. Some of these characteristics include a focus on providing timely, usable and valuable data that can drive decision making and behavior change; open, transparent and trustworthy governance that encourages competitors to share data; services that are patient-centered and easy for providers; and serving as a collaborator to bring together broad stakeholder groups involved in exchanging both clinical and non-clinical data to support whole patient care.

“HIE is a critical component to transform healthcare.  New payment and delivery models are still evolving, as is the role of HIEs in supporting them.  That said, the New Models workgroup believes HIEs can be an important enabler of healthcare transformation,” says Jeri Kirschner, Federal Health Liaison, Orion Health and Co-Chair, NeHC HIE Learning Network workgroup on HIE Functions to Support New Payment and Delivery Models.

“Health information exchange can improve healthcare quality and help to contain costs— something our health system is under enormous pressure to achieve. Progress is being made to bring successful widespread HIE and all of its benefits to providers and patients nationwide, but challenges remain. The NeHC HIE Learning Network has worked collaboratively to tackle tough issues and develop solutions that we hope will continue to advance HIE,” according to NeHC CEO Kate Berry.