With 43 percent of facilities considering moving to an Accountable Care Organization model and 45 percent of respondents seeking to improve connectivity within their health systems, HIEs are more top of mind than ever, according to a recent Porter Research and Billian’s HealthDATA (Atlanta, Ga.) survey. The survey of more than 120 C-suite/director- level health executives, showed however that cost and funding are still the biggest barrier for exchanges. Cynthia Porter, president of Porter Research, spoke with HCI Associate Editor Jennifer Prestigiacomo about the current climate surrounding HIEs and what are provider’s true perceptions.
Healthcare Informatics: Were there any findings in this study that you found surprising?
Cynthia Porter: One thing was that 63 percent of our respondents believe that patients will benefit from HIEs. We also had asked them to rank their organizations in terms of the HIE requirements for meaningful use. Nearly half rated themselves as mostly prepared for Stage 1, but what I found interesting is that 10 percent said they were ready to meet the requirements for Stage 2 and 3. And why that’s so interesting is that requirements for Stage 2 and 3 aren’t out yet. These results echo those of a recent CHIME study where the percent of CIOs who expect their organizations to qualify for meaningful use incentive payments dropped from 28 percent to most recently 15 percent. You really got to look at some of these organizations on a case by case basis to get a true picture of where we are at this stage. So, I found that this ranged all over the place from people being prepared and ones that didn’t even know.
HCI: Why do you think that respondents, when asked who benefits most from the HIE, had such low responses for “physician” and “health system”?
Porter: The physicians and the hospitals are going to have the costs associated with an HIE. And this not only includes finding the budget, but finding the resources, the technical challenges, and the political challenges with sharing information between separate legal entities. If you look at patients, they are the immediate true winner, and they really don’t have any cost now associated with an HIE. The other area that came up to be the second winner is the community.
HCI: Why do you think the centralized data warehouse was the preferred data architecture for HIEs?
Porter: Cost and security are the number-one reasons. Centralized data warehouses are the first step to cloud computing, which is really three to five years away. Cloud computing really has enormous benefits. What they really focus on is the new delivery model which includes the ACO and the medical home. I believe the providers are very hesitant to adopt cloud computing at this stage because they’re still worried about security. But the cost effectiveness of this kind of service will probably outweigh security concerns, especially after more and more providers find out how effective the cloud is through platforms like HIEs.
HCI: Why do you think there are so many organizations out there unsure about which HIE vendor to consider?
Porter: From our study, 48 percent of the market was not sure who was even a market leader. Forty percent weren’t even sure who they’d consider. The HIE market, even though it’s been around for about 20 years, is still a very immature market where even the industry leaders have very small revenues and a small client base. CIOs at hospitals, they’re used to making decisions about technology for the inside walls of their hospitals, for example a radiology system. But the selection of an HIE solution impacts not only the hospital, but the owned affiliates, the clinics, the laboratories, the imaging centers. There are so many more stakeholders’ fingers in the cookie jar. I think when we go to HIMSS we’re going to see over 55 vendors—I bet you even more—saying that they’re an HIE vendor.
HCI: What does the split between those who wanted a company solely focused on interoperability vs. their current acute EHR vendor for their preferred supplier type tell you?
Porter: It seems to be a two-sided coin there on how to choose a type of vendor. Do they stay with their current EHR vendor, someone they’re really comfortable with, and take the chance that the EHR vendor seamlessly hooks into other areas? I really believe that the split indicates that healthcare providers are not yet certain the best way to achieve genuine healthcare information exchange. If you look at those that prefer their EHR vendors, they’ve likely just gone through a recent technology conversion, a major capital expense and they’re looking simply to extend the reach of the infrastructure already in place—really trying to minimize the headache of adding in another technology layer. And this may not in the long run be the shortest or least stressful route. However, the EHR systems, they’re not really designed in the way to perform in the way you need for the new coordinated care model and share the data from an acute to an ambulatory environment and back. Some of the EHR vendors are scrambling to meet this new demand through partnerships, which is a great way to do it, or to bolt on functionality.
Likewise, [there are] those looking for an interoperability vendor who desire to use what they already have in place and leverage the legacy technology investments by adding an overlay technology to facilitate the data exchange. This is a slightly more promising approach, as interoperability solutions were built to handle data exchange among legacy or disparate systems. We don’t really feel that the EHRs were originally built that way, but both of those approaches have their strengths and weakness.
HCI: What sustainability models do you think will emerge as clear winners for the future?
Porter: When we did this study, nearly two-thirds thought the federal government should provide funding. What you’re seeing is what we call a value perspective, where an HIE defines financial stability by who is receiving the value, and what value are they gaining from participating in the HIE. Hospitals look at some of their internal cost savings that will help them with the sustainability, as most of the multi-hospitals thought that the decreased cost of chronic care was really going to help them with sustainability. A lot of the other hospitals felt that the reduced medication errors and redundant tests [were a road to sustainability]. A lot of analytics are going to be important to see who got the value, just like an ACO. Who’s getting paid? In order for an HIE to achieve sustainability, they must present and sell the value to be gained for each stakeholder and this really requires an extensive analysis for each type of stakeholder.
HCI: Do you see payers and health plans, which are generally not currently paying for HIEs now, getting into the mix?
Porter: A lot of [respondents] thought the payers were right behind the federal government of who should be paying for HIEs. I think ultimately the payers will have involvement in HIEs, and the reason is because they’re taking such a stake in Accountable Care Organizations. And it’s logical to presume they are initiating pay for performance programs and working with providers to truly develop coordinated care.
HCI: What will continue to be the main challenges surrounding HIEs besides sustainability?
Porter: I think one of the most overlooked challenges facing providers is who wants to become part of an HIE. Especially, if you look at the rural communities, there’s a lack of bandwidth. Some communities are just not equipped enough with wireless infrastructure to get the ball rolling, which then begs the question about where to get the funding. How long does it take to get set up and operational? I spoke with Vivian Funkhouser at Motorola at a meeting, and she said the most popular topic on the provider’s mind was wireless for HIEs. It may not be as glamorous as sustainability, but it’s a real concern nonetheless.