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HIEs Nationwide: An Evolving Mosaic

September 29, 2010
by Jennifer Prestigiacomo
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Hies Now Cropping up Across The Country are Taking Various Shapes, But All Face the Key Challenge of Sustainability

EXECUTIVE SUMMARY

As the health information exchange (HIE) concept evolves forward across the U.S. healthcare industry, leaders of different HIE organizations are pursuing divergent strategies that meet the needs of their regions. But a key, largely unresolved, issue around the sustainability of funding remains common across the sector.

Evie Nickison (middle) trains nurses Kristen Merrill (right) and Amy Hurt (left) on how to use Cerner Powerchart EHR at the new Internal Medicine Associates office in Mishawaka, Ind. Photo: Hannah King
Evie Nickison (middle) trains nurses Kristen Merrill (right) and Amy Hurt (left) on how to use Cerner Powerchart EHR at the new Internal Medicine Associates office in Mishawaka, Ind. Photo: Hannah King

As the healthcare industry moves toward meeting the meaningful use requirements around clinical data exchange, different regions and states are approaching health information exchange (HIE) very differently. According to a June report from the Orem, Utah-based KLAS, about 100 HIE organizations that use commercial solutions are live and sharing patient data. No one model has proven to be the standard for success. With a very broad range of governance and operating models, the resulting HIEs all have singular sets of experiences compelling their information exchange. And with public grants for HIEs resulting from the Health Information Technology for Economic and Clinical Health (HITECH) Act, long-term sustainability in this space remains the leading question HIEs face.

DIVERSE BEGINNINGS

Just like snowflakes, each HIE has a unique genesis. HealtheLink, the eight-county western New York State HIE whose service area includes Buffalo and Niagara Falls, got its start in 2004 when the Buffalo Academy of Medicine published a white paper on the interoperability of moving clinical information among a patient's healthcare providers, with the help of the neighboring physician community, the University of Buffalo, local public health agencies, and others. Several state and federal grants followed that helped pave the way, including one under the Health Care Efficiency and Affordability Law (HEAL NY) in August 2008. Now, HealtheLink has more than 700 providers and 3,000 users (including physician staff) sharing health information.

The Utah Health Information Network (UHIN) had a different start from that of most HIEs. It began in 1993 as an electronic administrative exchange, sharing claims, remittances, eligibility orders, and other HIPAA-compliant data exchanges, and now covers 90 percent of the medical providers in Utah. After a couple of false starts, UHIN started sharing clinical health information this year. According to UHIN President and CEO Jan Root, Ph.D., the organization first went down the path of trying to get clinical information to pay claims, and subsequently found out that that methodology wasn't effective. “We have to start with clinical information on the clinical side, then figure out how to get that to the billers secondarily,” says Root. “That's what we're doing now with the Axolotl product [San Jose, Calif.]; it's really designed for clinicians to use.”

(from left) Dr. David Blumenthal, national coordinator; Dan Porreca, HealtheLink, executive director; Congressman Brian Higgins; and Dr. Richard Daines, New York State Health Commissioner congregate in HealtheLink's Learning Lab. Photo: Doug Benz
(from left) Dr. David Blumenthal, national coordinator; Dan Porreca, HealtheLink, executive director; Congressman Brian Higgins; and Dr. Richard Daines, New York State Health Commissioner congregate in HealtheLink's Learning Lab. Photo: Doug Benz

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