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Making the HIE Connection

October 25, 2011
by Richard R. Rogoski
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Vendors try to meet growing demand in a rapidly expanding sector

As the number of health information exchanges (HIEs) increases across the country, vendors that supply connectivity solutions are scrambling to meet the demand.

According to “Health Information Exchanges: Rapid Growth in an Evolving Market,” a report published in June 2011 by the Orem, Utah-based KLAS (, the number of live HIEs successfully exchanging data more than doubled between 2009 and 2010, and several hundred more are now in development.

One of the report's most surprising findings is the ratio of public to private HIEs, says Mark Allphin, clinical research director for health information at KLAS. “While the number of live public HIEs that KLAS was able to validate increased from 37 last year to 67 this year, the number of private HIEs that KLAS validated exploded from 52 to 160,” he says.

The report is based on interviews with 239 providers associated with 227 live HIEs; it does not include HIEs that were under development. The number of validated HIEs for each vendor should not be interpreted as that vendor's market share.

A vendor must have at least six validated live HIEs reporting to receive a performance score. On the other hand, to receive a ranking, the organization's product has to meet the minimum “KLAS Konfidence” criteria, Allphin explains. “We will not give a product a ranking until we talk to 15 organizations that use it.”


Allphin observes that although there is a wide array of vendors serving this market, the cream is beginning to rise to the top.

KLAS ranks Medicity Novo Grid as No. 1 in the private HIE sector, with an overall performance score of 84.3 out of 100. In the No. 2 spot is RelayHealth Virtual Information Exchange (79.0), followed by Cerner Hub, with a score of 70.8.

Two vendors that are well-regarded by those working predominately in a Cerner or Epic environment are Cerner, which has seen rapid growth in the private HIE market, with 21 validated HIEs, and Epic, which has 26 private HIE customers, and whose Care Everywhere scored a 92.9. Both companies are currently working on ways to connect to other vendors' systems, Allphin says.

In the public HIE solution space, Axolotl (OptumInsight) Elysium Exchange receives a performance score of 83.8, while Orion Concerto Exchange scores an 85.5. These two, however, are not ranked because they don't meet minimum KLAS Konfidence levels, Allphin says.

Medicity's rise to the top in this year's report reflects the attributes that providers say they need. “Medicity Novo Grid has simple architecture and is easy to plug in,” Allphin explains. The report also notes that Medicity has been in the HIE business longer than most vendors, and continues to be a market leader with 33 live private HIEs and five live public HIEs that are validated by KLAS. However, the recent acquisition of Medicity by Aetna has some customers concerned about the entry of payers into the HIE market, Allphin adds.

RelayHealth has grown from eight KLAS-validated live HIEs last year to 24 this year. The report's authors note that: “RelayHealth has seen substantial growth in the past year as they continue to leverage their portal/personal health record solution to help customers build viable HIEs. While some providers report some frustrations with interfacing and unmet expectations, others feel RelayHealth is a strong partner that is working hard to improve.”

The purchase of Medicity by Aetna is not the only indication that payers are now entering the HIE marketplace. UnitedHealth/Ingenix recently purchased Axolotl and renamed the company OptumInsight. Regardless, the newly branded vendor has 14 live public HIEs, more than any of its competitors, and is making a deep penetration into the private HIE market as well, with eight validated private HIEs, Allphin says.


Dick Thompson, executive director and CEO of Grand Junction, Colo.-based Quality Health Network (QHN), has been satisfied with Axolotl's product and its customer/technical support. He hopes that does not change because of the buyout, but, he does believe the jury is still out.

Reprinted with permission from KLAS.
Reprinted with permission from KLAS.

Going live in October 2005, QHN now connects 640 active providers, and has more than 2,500 online users. Five hospitals are already connected, and two more are in the process of being added within the next 45 days, Thompson says, adding that four more hospitals have agreed to connect, with completion expected by early 2012.

The area served by QHN includes western Colorado and eastern Utah and it will eventually be connected to both statewide networks, Thompson says. But even after that happens, QHN's focus will remain local, he stresses: “Our founding organizations envisioned an all-inclusive non-profit, apolitical network focused on improving quality. Our focus was to create a medical neighborhood. The best return on investment is to create a locally driven HIE. I think that's the key, because healthcare is largely local.”


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