Forty-seven percent of primary care-focused community clinics in California participate in health information exchange, according to a recent survey by California Health eQuality (CHeQ), the organization tasked with promoting coordinated care through HIE in the Golden State.
EHR adoption was reported at approximately 80 percent, with most reporting having achieved meaningful use. Perhaps surprisingly, 73 percent of rural clinics reported participating in HIE. Although the reported HIE participation rates are high, many of the clinics are exchanging data only within their own organizaitons and only with one or two partners.
Previously there has been little research on community clinic participation in HIE, said Katherine Kim, a professor in Residence at San Francisco State University’s Health Equity Institute, who led the research project last fall. Her organization surveyed 159 urban and 33 rural clinics as well as the corporate offices of multi-clinic corporations.
Kim said that the respondents reported a broad range of data partners and data types being exchanged. Among partners, 85 percent are exchanging data with labs, 59 percent with hospitals, 37 percent with physician offices and 25 percent with public health. Lab orders and results top the types of data along with radiology orders and results followed by summary of care records.
When asked about the financial impact of HIE, 38 percent said it decreases costs, 31 percent said it increases costs, and 23 percent saw no change. One survey respondent said HIE needs to be in place for 18 months to three years before you can understand the impact on costs and revenue.
“Urban clinics and solo sites are lagging their rural and corporate counterparts,” Kim said. “They may need more resources to catch up.”
When asked about data standards, only 9 percent mentioned making use of the Direct standard for transport. When asked about HIE services, 53 percent said they manage them internally and 47 percent outsource them. Of the outsourcers, 15 percent outsource to hospitals or health systems and 30 percent turn to a community clinic consortium.
Of the multi-clinic corporations, 67 percent are exchanging with other clinics in their own organizations while only 52 are exchanging data externally. Among the barriers mentioned in the survey were the difficulty in recruiting and keeping experience IT resources in house and HIE consent. Respondents said both technical and policy aspects of consent are not clearly developed yet.