Health information exchanges (HIEs) see their involvement inaccountable care organizations (ACOs) and patient-centered medical homes (PCMHs) as a key to their own long-term sustainability, according to survey results released by the eHealth Initiative.

During a Sept. 27 webinar, the nonprofit eHealth Initiative released preliminary results of its 2012 Health Information Exchange (HIE) survey. One hundred and twenty-seven organizations completed the survey, and more than 40 percent of respondents are currently supporting either ACOs or PCMHs and another 25 percent say that they plan to do so in the future.

A few other initial highlights of the survey:

• 73 use a push model, such as Direct;

• 82 use a query model to retrieve clinical information; and

• 60 use end-to-end integration, with interfaces between systems that enable seamless exchange.

Of the respondents, only 11 HIEs described themselves as private, with participation restricted.

Ninety percent said they are likely to be operational in three years after the federal HIE state cooperative program ends.

A majority of respondents said they believe they will earn revenue to cover expenses once grant funding runs out, but they predict it will take 10 to 30 months.

A panel of HIE leaders responded to the initial results. Richard Swafford, executive director of the Inland Empire HIE in California, expressed some surprise that only five HIEs responded that charging fees for service was their sustainability approach. “You will see that number increase dramatically in the future,” he said. HIE is about volume, he said. You have to provide services that provide financial value. (Inland Empire provides both public services in two counties, and private HIE services to provider organizations.)

Trudi Matthews, director of policy and public relations of HealthBridge in Cincinnati, said her organization is working on defining its role in ACOs and PCMHs. The challenge, she notes, is that HITECH Act incentives focused on hospitals and physicians, while the ACO world includes a whole continuum of care that needs to be connected. “We are working with key long-term-care providers and behavioral health providers to facilitate data exchange, and they may not be using EHRs,” Matthews said, “so we have to figure out what kind of electronic tools fit in those environments.”

Carol Parker, executive director of the Great Lakes HIE in Michigan, says some EHR vendors have tried to convince customers that they don’t need to participate in public HIEs, because the vendors will provide that connectivity. “Some CIOs have told me that HIE is now a four-letter word to them. They felt that they put their trust in a system and it let them down. We all need to be concerned about that, because we don’t want HIEs to be seen in a negative light.”