Total Number of Live HIEs Exchanging Data More Than Doubles in Past Year

Health Information Exchanges (HIE) enable hospitals, physicians, and clinicians to improve the quality and efficiency of the care a medical community is able to provide to its patients through the electronic sharing of patient records. Thanks in part to Meaningful Use and other elements of healthcare reform in the United States, HIEs are now being formed, whether through a government-backed initiative or as private ventures.

Mark Allphin

In last year's HIE performance study, KLAS found that, although the market was full of vendors offering an HIE solution, only a few HIEs were actually up and running. The new KLAS report, "Health Information Exchanges: Rapid Growth in an Evolving Market," looks more deeply into the adoption level of HIEs, as well as the state of each vendor's HIE activity, and how well that vendor is responding to provider needs.

Among the highlights of the report:

• THE MARKET IS STILL A MILE WIDE, BUT SLOWLY GETTING DEEPER.
  The HIE market still has a wide array of vendors, and the total number of HIEs that KLAS has validated as live and exchanging data has more than doubled from 2009 to 2010. Several hundred other HIEs are in some stage of development.
• THE CREAM IS SLOWLY RISING TO THE TOP AMONG VENDORS.
  Determining which are the most viable players among the myriad of HIE vendors is becoming easier as some vendors continue to bring new HIEs live, while others are seeing little growth.
• THE BULK OF HIE MARKET GROWTH IS IN PRIVATE HIES.
  While the number of live public HIEs KLAS was able to validate increased from 37 last year to 67 this year, the number of live private HIEs KLAS validated exploded from 52 to 160.
• MOST PHYSICIANS STILL HAVE TO LEAVE THEIR WORKFLOW.
  Although physician adoption was cited most often as a key indicator of HIE success, most HIEs still have work to do in making the system physician friendly. Among the live HIEs that KLAS validated, only 43% were delivering patient data directly into physicians’ EMRs.
• FUTURE FUNDING IS STILL A MAJOR CONCERN IN PUBLIC HIES.
  Of public HIEs interviewed, 54% expressed concern about future funding. Only 35% of private HIEs had the same worry.

"The HIE market continues to mature since last year's report, and a number of vendors are beginning to stand out from the crowd," said Mark Allphin, author of the report. "But, most HIEs still have a long way to go before they will be able to start making the positive impact on healthcare that providers and regulators are hoping for. Interestingly, the number of live private HIEs has increased more rapidly than the number of live public HIEs."

Public vs Private HIEs--why is one gaining more traction than the other?

Since 2010 the number of live public HIEs rose from 37 last year to just 67 this year, while the number of live private HIEs mushroomed from 52 last year to 161 this year. Data collected for this report revealed two main reasons public HIEs are not going live as quickly as private HIEs:

1) Governance - between the complications inherent in government-sponsored initiatives and the difficulty of getting competing healthcare organizations to agree on what to share, public HIEs have had a hard time earning physician acceptance, whereas private HIEs need not depend on public funds and/or government oversight.

2) Funding - at this time there are numerous grants and funding options available, but providers are very concerned that given normal economic and political upheavals monies may dry up at any time, leaving them without the means to continue functioning.

One director at a public HIE commented, "The fact that our funding is dependent on political support in difficult economic times is worrisome. . . With new faces in the federal and state legislatures, there are no guarantees." Private HIEs, however, are typically funded by the stakeholders themselves, so future funds are less of a worry.

Physician reticence--doctors may be exacerbating the hold-up

According to respondents, physicians may be contributing to the lag in deployment of public HIEs. Providers reported that doctors are interested in HIEs, but not if they cause them to lose time searching for or wading through too much patient information. Concerns over data integrity and having outside providers push data into physician's EMRs were also voiced as contributing to the low adoption of public HIEs in the United States.

One provider related, "The doctors were interested in this to start out, but once they realized that they were going to have to do things in two different places, they lost interest. It is just too cumbersome." With that challenge in mind, more HIEs are striving for ways to deliver useful data to physicians without requiring them to leave their normal workflow, but so far progress has been slow.

More than 230 HIE customers were interviewed for this study. Together they evaluated a total of 35 HIE vendors. In the case of private HIEs, Medicity, RelayHealth, and Cerner ranked highest in performance scores. Although Epic Care Everywhere scored higher than all three, Epic was not ranked in this report because nearly all of the Epic exchanges KLAS was able to validate were between Epic hospitals. One Epic HIE was with a non-Epic EMR system. In the case of public HIEs, both Axolotl and Orion scored 83.8 and 85.5, respectively. However, neither solution was ranked in the report because they did not meet the minimum KLAS Konfidence levels.

"While HIEs have made substantial progress over the last 12 months, the market is clearly still in the early stages," added Allphin. "The majority of HIEs are building the foundation for what they hope will become robust and meaningful exchange models. Meaningful Use will continue to put pressure on providers to make patient information accessible across the continuum of care, and with the rapid evolution of healthcare in the United States. HIEs will only increase in importance going forward."

For more information about the health information exchange market, as well as the strengths and weaknesses of measured vendors, "Health Information Exchanges: Rapid Growth in an Evolving Market" is available to healthcare providers online for a significant discount off the standard retail price.


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