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Black Book: Frustrations Growing Among HIE Users

April 8, 2016
by Rajiv Leventhal
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Research finds that 57 percent of users hold their HIT vendors culpable for data siloes, information blocking

There has been growing health information exchange (HIE) user frustration over the lack of standardization and readiness of unprepared providers and payers, according to a new survey from Black Book Research.

For the survey, more than 2,000 provider HIE users and 2,000 payer HIE users, as well as more than 4,000 prospective HIE users of all user types were polled to understand the importance of interoperability in their strategic planning initiatives, as well as their ongoing and new challenges in areas such as connectivity and data exchange. Twenty-six percent of self-identified connectivity-ready hospitals intend to keep expanding into robust exchanges for value-based payment prospects with primed payers, despite the delays by peer providers to electronically share patient data beyond meaningful use, the research revealed.

Of those still lagging behind in prioritizing interoperability, collectively only 17 percent place the blame on their organization’s available funding or executive interest level, while 57 percent place culpability on their HIT/electronic health record (EHR) vendors for connectivity defects and siloes or data blocking. And 20 percent blame their respective government agencies for slow progress in development and standards.

“Every stakeholder in the healthcare delivery process cannot establish the infrastructure needed to support interoperability, as evidenced by 83 percent of physician practices responding and 40 percent of hospitals, that currently admit they are still in the planning and catch up stages of sending and sharing secure, relevant data, “ said Doug Brown, managing partner of Black Book. 

What’s more, 63 percent of hospitals and hospitals systems report they in the active stages of replacing their current HIE system, whether private, public, homegrown or EHR-dependent with a variety of options including middleware and more advanced HIE systems.  Nearly 94 percent of payers surveyed intend to totally abandon their involvement with public HIEs and work directly in regions and states to create and/or bolster private enterprise HIEs which more directly meet their needs to facilitate accountable care initiatives with providers. “The misalignment of requirements and protocols has hampered all the stakeholders’ interoperability efforts,” said Brown.  “This disorder is ushering in a new replacement revolution, this time for those HIEs failing to meet the expectations of their users, payers and providers alike.”

Brown added, “The value-based payment reform concept enabled by a robust HIE requires all stakeholders including physicians, insurers, post-acute care, and diagnostic facilities, not just hospitals to reach the goals of dynamic population health. Focused, private HIEs also mitigate the absence of a reliable Master Patient Index and the continued lack of trust in the accuracy of current records exchange.”

According to the survey results, 39 percent of hospitals currently implementing or evaluating private regional networks intend to participate in regionally-centered enterprise HIEs with contracted payers to ensure greater connectivity among the stakeholders with whom they network within a geographic healthcare market. “The challenge of turning silos of medical and financial information into a linked, complete, accurate secure lifetime medical record is still tenuous,” said Brown.

Ninety percent of polled hospitals see private HIEs as a potentially more profitable model that can be sustained as the industry evolves faster towards a values-based and outcome-based healthcare delivery and reformed payment model.

Black Book also noted that payers have been largely absent in the development of dozens of private HIEs until late 2014 because data sharing was viewed as mainly benefitting providers.  “Public HIEs and EHR-dependent HIEs were viewed by 79 percent of providers as disenfranchising payers from data exchange efforts and did not see payers not as partners because of their own distinct data needs and revenue models,” said Brown. However, 88 percent of hospitals and 95 percent of payers in Q1 2016 see secure data exchanges where all parties pay a fair share in the development and maintenance is creating a more collaborative trusting relationship.

Since 2013, the number of private HIEs involving a payer/multi-provider collaboration have increased steadily. Sixty percent of providers that year reported they distrust payer guided HIE initiatives. In 2016, 93 percent of providers are considering cooperative HIE to satisfy the growing need for data particularly to manage complex patients and integrate clinical and financial data sets. “Progressive payers are moving rapidly into the pay-for-value new world order and require extensive data analytics capabilities and interoperability to launch accountable care initiatives,” said Brown.

In response to alleviate concerns of HIEs with poor connectivity outside their integrated delivery networks (IDNs) and hospital systems, interoperability middleware is also a fast growing consideration according to 16 percent of hospital systems IT leaders with EHR-dependent HIE grievances, in particular. “The middleware software sits within the data pipeline and translates data from disparate EHRs which shows promise for private HIEs, particularly payer-centric enterprise models,” said Brown. “It creates a business intelligence layer that provides information to all stakeholders in real time.

Researchers noted that some vendors have refused to open their HIT and EHR systems to complete bidirectional interoperability and the Office of the National Coordinator for Health Information Technology (ONC) has not used enough of the hammer to enforce interoperability on EHRs and HIT vendors according to 85 percent of hospital leaders surveyed, 88 percent of physicians and 92 percent of payers participating.

In 2013, 82 percent of all payers and 60 percent of participating hospitals agreed that an operational national HIE is at least a decade off. In 2015, 91 percent of all payers and 74 percent of providers believe that a robust, meaningful national HIE will now be achievable by 2020 if more private or enterprise HIEs are created and a patient locator system is implemented.

Promises made in the recent interoperability pledge for three core commitments from EHR developers (providing patient access, eliminating information blocking, and implementing federal connectivity standards) won’t be the reason why interoperability succeeds, predicts Black Book’s survey results. 

Finally, 57 percent of providers also confirm their beliefs that the whole interoperability industry will evolve by leaps by 2018 if some basic issues are addressed, with or without a vendor pledge.  “Progressive FHIR standards can allow EHRs to talk to other EHRs should standard definitions develop on enough actionable data points as we are enter a hectic period of HIE replacements, centering on the capabilities of open network  alliances, mobile EHR, middleware and population health analytics as possible answers to standard HIE,” said Brown.

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In response to alleviate concerns of HIEs with poor connectivity outside their IDNs and hospital systems, interoperability middleware is also a fast growing consideration according to 16% of hospital systems IT leaders with EHR-dependent HIE grievances, in particular.

“The middleware software sits within the data pipeline and translates data from disparate EHRs which shows promise for private HIEs, particularly payer-centric enterprise models,” said Brown. “It creates a business intelligence layer that provides information to all stakeholders in real time.”
Middleware is gaining popularity fast by hospitals using EHR-dependent HIE systems with extremely expensive custom development for data sharing outside the network. Black Book evaluated middleware vendors in an associated Q1 2016 user survey, ranking HealthMark, Zoeticx, and Arcadia Healthcare Solutions highest in satisfaction among new users.

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