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Tracking the Evolution of HIEs

July 29, 2010
by Mark Hagland
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Web-Exclusive Interview: Jennifer Covich, CEO, eHealth Initiative

Last week, the Washington, D.C.-based eHealth Initiative presented a one-day forum on the development of health information exchanges (HIEs). In conjunction with that event, held in Washington, D.C., the eHealth Initiative organization released the results of a nationwide survey of HIEs. Jennifer Covich, chief executive officer of eHealth Initiative, spoke this week with HCI Editor-in-Chief Mark Hagland regarding what was revealed in her organization’s survey.

Healthcare Informatics: How many HIEs do you believe are now in existence?

Jennifer Covich: I believe there are at least 250.

HCI: What level of sustainability do you see out in the industry among those approximately 250 HIEs?

Covich: It depends on your definition of sustainability. Among survey respondents, 107 of the 199 organizations that responded told us they weren’t dependent on federal funding. Then, we took the data and broke it down further; out of those 107, we determined how many organizations were operational, and were transmitting data between at least two different stakeholders; and that number was 73. Then, of those 73, 44 are not at all dependent on federal funding. We further asked them whether they had yet broken even financially; and 18 of those 44 HIEs had broken even as a result of operational revenue.

HCI: You also found that the leaders of 131 initiatives cited addressing government policy mandates as a major challenge.

Covich: I think that’s about meaningful use. And there are a lot of mandates coming not just out of ARRA-HITECH [the American Recovery and Reinvestment Act of 2009/the Health Information Technology for Economic and Clinical Health Act], but also out of healthcare reform. And there’s also the switch from the ICD-9 coding system to the ICD-10 system.

HCI: The fact that meaningful use mandates data exchange should also stimulate HIE, right?

Covich: Absolutely. If you look at stage 1 of the meaningful use requirements, there aren’t a significant number of health data exchange requirements, but those will ramp up with stages 2 and 3. But that doesn’t make it any easier to do. It’s always been difficult; it’s a young field, a new field, and this stuff is very difficult to do; and just mandating it doesn’t make it so. And what we’ve found in our research is that most of these exchanges take between one and three years to get up and running. So a lot of these mandates will take effect before the average amount of time that an HIE can get going. On the flip side of that, you do have a critical mass of organizations out there that know what they’re doing; but then you’ve got to get the rest of the country up and going.

HCI: Because of the radically different local and regional environments involved, every HIE seems to be developing almost uniquely. One analogy that comes to mind is that of the evolution the earliest cars a century ago, when every single model of car was quite different. Given that diversity, how can we accelerate the broader evolution of HIEs nationwide in the next few years?

Covich: Yes, there’s a balance to strike between standardization and innovation. I think we can do it and be successful, but it’s a really tricky line. You want to be able to connect on a national level, but you don’t want to hurt innovation, because that’s where the innovations will take place that will handle patients. The good news is that with a lot of these programs that we look at in terms of care coordination and HIE, they involve some straightforward things, like providing e-mail to patients. If we just use the capabilities and technologies we have now, we can go a long way, and have a positive impact on patient care. We don’t need fancy rocket ships; a lot of the tools being used that are successful, are simple.

HCI: HIE initiatives are increasing the deployment of personal health record (PHR) tools. What are your thoughts about that?

Covich: It’s a great result. I think it’s a step in the right direction; it’s the way we need to be going right now. The more engaged the patients are, the better. And 71 initiatives now have consumers involved in governance; that’s up from 22 last year. That’s pretty significant, and I think that signals that organizations are realizing that consumer involvement is very important. I was pleased to see that. Also, advances are being made in terms of communication between patients and providers—33 organizations are doing that in 2010.

HCI: Were the results of the survey overall about what you thought they might be?

Covich: The results are very encouraging; we weren’t sure what kind of effect ARRA might have. I think it confirms that ARRA has had an effect. Specifically, I think the concerns about meeting government mandates were another finding that was enlightening, if not quite surprising.


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