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Health Information Exchange: Moving Forward or Stuck in Neutral?

April 22, 2014
by Rajiv Leventhal
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In a still-young, but growing market, debate has arisen on whether or not HIE is headed in the right direction

Recent reports say that the global health information exchange (HIE) market is projected to reach $878 million in 2018, growing at a compound annual growth rate 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.

As such, even as HIE technologies continue to grow in number and in breadth of scope, many healthcare leaders within and outside HIE organizations see stumbling block after stumbling block facing the sector over the next few years, and are asking what, if anything, could address the problems they see as hampering the long-term success, stability, and sustainability of health information exchange. Within these challenges lie vendor-market uncertainties. A report in March from the Orem, Utah-based KLAS research of 219 HIE providers found that overall provider satisfaction with HIE solutions dropped an average of 8 percent since last year, as provider demands outpaced vendor delivery. According to the report, grants are exhausted, public HIEs are struggling, and vendors are trying to deliver long-term value. At the same time, most vendors continue to experience flat or falling performance scores from customers, the research shows. Is this an inflection point for health information exchange?

Vendor executives, provider executives, and HIE leaders all have concerns. Sumit Nagpal, CEO of Alere Accountable Care Solutions (ACS) a Waltham, Mass.-based vendor with an HIE solution, says the industry has been stymied because of all the challenges that the vendor community has put up for the industry. “The vendors still have not really bought into opening up their silos and making data available for everything that they are needed for, because they haven’t figured out what they will be giving up by making that happen,” Nagpal says. “The provider organizations are wrestling with the same real considerations—what advantages are they giving up that they worked so hard to create?”

Sumit Nagpal

Nagpal goes on to say that for vendors, the sacrifice is clear: one vendor “winning” means some other vendor “lost,” so really, the way the vendor community is growing is by taking business away from other vendors, he says. “Essentially, they’re saying interoperability is a bad thing. Best-of-breed is dying a slow death for that reason. It’s much more of a benefit to the leading players if their own systems are involved in all the departments rather than making it easy for customers to pick and choose what they would like. They would be giving up a significant advantage—that’s the vendor problem.”

The provider problem, Nagpal continues, is that if providers give transparency into patient information, that puts the patients more in control of where they go and seek care, and puts other providers on a level playing field, as patients can alternate their sources of care. “Patients and providers can shop around, and this is the real business reason why HIE is not flourishing,” says Nagpal.

According to Micky Tripathi, Ph.D., CEO of the Massachusetts eHealth Collaborative (MAeHC), in some ways, demand has outpaced delivery, as providers certainly want to do things that vendor technology doesn’t allow right now. “Part of that is a vendor technology issue and some of it is an ecosystem issue,” he says. “In some cases, the vendor technology itself won’t do the kinds of things that a provider wants, such as a customized continuity of care document [CCD] for different use cases, where the technology might only be programmed to do a meaningful use compliance CCD, and that’s it. That’s not very nimble, it’s a vendor restriction,” says Tripathi. “The ecosystem restriction would be, ‘My vendor could do these things, but I have no one else to connect to.’ They’re on a different system or in a different HISP [health information service provider]—in a way, many of the issues we’re experiencing today feels like the early days of email.”


Chuck Podesta, senior vice president and CIO of Fletcher Allen Health Care, a Burlington, Vt.-based integrated health system, says things are getting more difficult, rather than less, in HIE as everyone is trying to find a sustainability model. “I think the solution for these HIEs is really their partnerships with accountable care organizations (ACOs). I’m on the Vermont Information Technology Leaders (VITL) board, so part of our sustainability strategy is to really connect with these ACOs, because we can charge a per-connection fee,” he says, “and in some of the smaller ACOs, the HIE can even be the analytics partner as well. But it’s very hard to show value to an individual physician’s office, and charge that individual physician for each use. That’s a really big struggle. So if you can’t connect with an ACO, it’s going to be difficult.”

Contrary to Podesta’s and Nagpal’s beliefs that HIE isn’t flourishing—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 says—other health IT leaders, including Tripathi, feel that health information exchange is indeed thriving.


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