State HIEs: The Glass is Half…

For advocates of Health Information Exchanges (HIE), a new study on repeat imaging offers encouragement.

As reported in January in Healthcare IT News, researchers at Weill Cornell Medical College found that participants whose medical records were accessed through an HIE within 90 days were significantly less likely to have repeat imaging tests.

The study comes on the heels of a more somber assessment from the Rand Corporation last December, which questioned the financial viability of most HIEs, while citing multiple barriers to their adoption and use.

So is the HIE glass half-empty or half-full? A thorough and just-released report from the National Opinion Research Center (NORC) doesn’t answer that question, but is worth a read to better understand the challenges facing State HIE programs.

A closer look
To recap, the HIE program sponsored by the Office of the National Coordinator (ONC) began in 2009 and has provided $564M to states to facilitate and expand the secure exchange of healthcare information.

The NORC study, published in December, assessed HIE initiatives in six states – Iowa, Mississippi, New Hampshire, Utah, Vermont, and Wyoming. describes three forms an HIE can assume, Directed Exchange, a Query-based Exchange and a Consumer Mediated Exchange. NORC reports most states opted for a both a Directed Exchange (information is “pushed” between providers) and Query-based Exchange (information is “pulled” from information repository in response to a query from a care provider). The NORC report additionally describes state HIEs as being a federation of decentralized repositories of patient information, a centralized hub repository or a mixed hybrid.

The Directed Exchanges require providers to work outside of their EHRs, accessing the secure messaging system through a web portal. As a result, “direct use is low,” notes NORC.

Lack of content in the Query-based Exchanges is another hurdle cited by users.

“Stakeholders reported it is very damaging to the reputation of state efforts when provider queries return insufficient results, leading users to conclude the system is not useful.”

Another challenge to user adoption: interoperability.

“Stakeholders in all six states reflected on the need for truly interoperable systems, currently absent because of lack of adoption and inconsistent implementation of available standards for vocabulary and exchange, variability in document formats, and issues with interface designs.”

Advantages of the State HIE program were noted. The report identified a growing “awareness of HIE and the benefits of exchanging information” and identified “a deeper comprehension of how HIE fit into the bigger picture of health, health reform, and desire for HIE capabilities” as benefits of the program.

The NORC report also highlights intentions not yet realized. Utah, for example, is currently developing a centralized data repository through the clinical health information exchange (cHIE) to aggregate lab results, medication history, problem lists, and allergies data.

Progress in Maine
Clearly, HIEs are early-stage and results to date are mixed at best. I still believe they are a needed component of 21st century healthcare. I take encouragement from a 2012 NORC report highlighting Maine’s HIE, a statewide initiative undertaken prior to the HITECH act. The Maine program has enjoyed significant support from providers, and its keys to success include:

  • Heavy IT infrastructure that includes a central data repository
  • Stakeholder buy-in through broad representation on committees and boards
  • Focus on supporting ,not disrupting workflow

One has a sense of vision and direction driving the Maine HIE. Take, for example, the announcement this month that Maine is offering predictive analytics and reporting to its participating members.

My sense from all of this is that some HIEs will continue to stumble and yes, even fail. But if given time, other HIEs will take root and provide real value. Put me firmly in the camp hoping for the latter. I prefer my glass half-full.