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Health Information Exchanges Are Coming of Age

The number of health information exchanges (HIEs) in the U.S. is soaring. While some recently formed exchange initiatives are looking to capture federal funds, the big increase in the number of operational HIEs appears to be unrelated to the $300 million that the economic stimulus legislation authorized for HIEs, since most of those exchanges have been in development for some time.

The annual survey of the eHealth Initiative, a nonprofit organization based in Washington, DC, shows that there are now 57 operational HIEs, up from 42 in 2008. Overall, 150 HIEs completed the 2009 eHealth Initiative survey, compared with 130 last year. In addition, the organization identified 43 HIE initiatives listed in the previous survey that are still functioning but didn't respond to the poll. So there are nearly 200 HIE efforts at some stage of planning or implementation, and they're found in all 50 states and the District of Columbia.

Some other key findings of the survey: • Forty of the operational HIEs reported cost savings in such areas as handling lab and radiology results, reduced staff time on administrative tasks, and fewer redundant tests. • Of the operational exchanges, 21 reported a return on investment for hospitals and 19 reported ROI for physician practices. • The number of types of data being exchanged is increasing. • Seventy-one of the respondents report they are not dependent on federal funding, and only 30 are. • State governments have an involvement with 83 HIEs, of which more than half are receiving state funds.

While 90 of the HIE initiatives said that finding a business model remains a challenge, the fact that more are weaning themselves away from government funding is encouraging. Also, some of the HIE efforts appear to be broadening their focus. For example, a third of them are providing clinicians with health IT implementation assistance--something that will be sorely needed when more physicians start adopting EHRs in anticipation of federal incentives for meaningful use. And, while results delivery is a function of 77 percent of the operational HIEs, the majority of them are also beginning to connect to participants' EHRs. This capability will be crucial for showing meaningful use down the line.

The formation of HIEs can be expected to accelerate in coming years, not only to garner federal incentives, but also to meet hospital goals for closer alignment with physicians. While some hospitals are doing that by employing more physicians, others are using electronic messaging systems and HIEs to pull doctors more tightly into their orbits.

Regional information exchange have been growing for several years. Dr. David Brailer, the first National Coordinator of Health IT, promoted them back in 2004 as part of his national roadmap for health IT adoption. They weren't much of a force back then; but, if the eHealth Initiative report is any indication, HIEs' time may have finally arrived. Now, if we can just break down the walls that prevent information systems from communicating with one another directly, we will have a really powerful tool to improve health care.