As these new exchanges take off, challenges surface around the inherent differences in data standards and structures
With meaningful use requirements mandating the act of health information exchange, HIEs are set to evolve forward rapidly to meet myriad needs for the exchange of vital data and information going forward. Yet even as HIE development picks up pace, the “elephant in the room” around their development remains the overarching, yet unavoidable, question of sustainability.
What's more, the rapid pace of HIE development of late has also led to a proliferation of data exchange models and protocols, further fragmenting an already fragmented sector. Among the numerous elements in the HIE constellation include the still-emerging framework of the National Health Information Network (NHIN), the various state-level cooperative agreements, and a galaxy of different types of local HIEs, which may encompass just a single healthcare delivery system, or alternately may include numerous competing local health systems, according to Marc Overhage, M.D., Ph.D., CEO of the Indiana Health Information Exchange.
Still, as far as the overarching issue of sustainability is concerned, some industry observers believe that things are looking up at the moment. For example, Cynthia Porter, president of the Atlanta-based Porter Research, finds the current climate promising, with a recent survey her organization produced finding 250 reported HIEs in the country, 18 of which are self sustaining. “What this really suggested that was exciting was that HIEs can be self sustaining, without grant funding and the benefits of HIE are being demonstrated,” she says.
A HYBRID APPROACH
As if HIEs weren't already wildly diverse on many levels (including governance, funding, and organizational membership), their leaders are taking diverse approaches to data architecture, as well. Some, like Maine's statewide HIE HealthInfoNet, have implemented a central repository model, while others, like the Indiana Health Information Exchange, are taking a federated approach, and still others are blending the two models. John Druke, a partner at KPMG, and Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative, both believe that the federated model will win out as the standard, as they believe that a repository model can be too unwieldy to manage. Jason Hess, general manager of clinical research at the Orem, Utah-based KLAS Research, believes more HIEs will adopt a hybrid approach. “Wouldn't it be better [to share information] with an edge server approach, where that data is behind each entity's firewall, but then certain elements be easily shared?” he asks.
WHAT THIS REALLY SUGGESTED THAT WAS EXCITING WAS THAT HIES CAN BE SELF SUSTAINING, WITHOUT GRANT FUNDING AND THE BENEFITS OF HIE ARE BEING DEMONSTRATED.-CYNTHIA PORTER
THERE'S NOT A MODEL TODAY THAT'S PROVEN COMPREHENSIVELY TO WORK. THE TRANSITION POINT TO SUCCESS WILL INVOLVE HIES PROVIDING VALUE BACK TO THEIR PARTICIPANTS.-MIKE BEATY
At the same time, Hess sees the crowded vendor market growing in maturity, noting that a few years ago, many HIE vendors had only one or two clients, and now the same ones have four to five clients. He and others interviewed for this story cite the recent acquisitions of Axolotl (San Jose) and Medicity (Salt Lake City), by United Health Group's Ingenix Division (Eden Prairie, Minn.) and Aetna (Hartford, Conn.), respectively, as a bellwether for more consolidation and health plan participation in the future. “I believe the recent acquisitions are clear indicators of their [payers] interest in health information exchange either as a host of an exchange or as a beneficiary of the information flowing through it,” says Druke. “It's not clear exactly how they plan to use those assets, but I believe they view themselves as a part of any major exchange.”