Challenges, Alternatives, and Paths to Sustainability for Health Information Exchange Efforts

Abstract

Health information exchange (HIE) is a promising approach to improving the cost and quality of healthcare. We sought to identify the strengths and weaknesses of organizational models to achieve exchange, and what can be done to ensure the sustainability and effectiveness of exchange efforts. We interviewed state and national health informatics policy experts (n = 17). Data were collected as part of an evaluation of the Health Care Efficiency and Affordability Law for New Yorkers (HEAL NY) program and included respondents from both the private and public sectors. Data were analyzed using a general inductive and comparative approach with open coding of themes. Interviewees generally viewed HIE as a public or societal good to be valued. However, they identified challenges with the regional health information organization (RHIO) model of facilitating exchange including: economics, organizational issues, and geography. RHIOs were contrasted against alternative methods of exchange such as Direct, enterprise HIE, and vendor-mediated exchange. HIE is a difficult undertaking due to political and economic reasons. Alternatives to the RHIO model have features that may be more attractive to participants, but may be of less public benefit. Using states as intermediaries and mandating exchange under public health law may avoid the challenges facing exchange efforts. Moving forward, policies will have to address the shortcomings of each HIE model to ensure information is effectively shared between providers to maximize health benefits.

The potential for community-based health information exchange systems to reduce hospital readmissions

“…Current exchange approaches in the USA vary by the number and types of participating providers and how patient information is shared. 41,42 Currently, we do not know which forms of HIE will ultimately be most effective, or effective at all. However, this study suggests that the community-wide lookup approach offered by many HIE efforts could have clinical and economic value, particularly in the transition from inpatient to outpatient settings.…”

How could health information exchange better meet the needs of care practitioners?

“…Currently, providers have multiple options to meet Meaningful Use requirements that do not require the on-going exchange of data with a wide-variety of community providers as in the RHIO model. Exchange models like vendor-mediated exchange or enterprise HIE efforts may be limiting participation in RHIO and therefore limiting data available to RHIO users [47]. To address this option, the state could require providers to participate in a RHIO.…”

A Case Report in Health Information Exchange for Inter-organizational Patient Transfers

“…Gaining involvement and sustaining involvement in HIE initiatives has long been a barrier to implementation and sustainability [26,27]. Yet CCITI NY was able to develop a governance structure using financial, technical, and clinical workgroups that enabled administrators, physicians, and outside consultants to agree upon and operationalize technical as well as data standards.…”

“…Research has traditionally focused on safety within the context of intra-hospital patient transfers, but it is becoming increasingly clear that inter-organizational patient transfers requires new solutions that foster cross-institutional collaboration and feedback loops . Given our results, effort should be directed at understanding the technical, organizational, or user barriers to sharing patient transfer data, particularly from the hospital perspective.Gaining involvement and sustaining involvement in HIE initiatives has long been a barrier to implementation and sustainability [26,27]. Yet CCITI NY was able to develop a governance structure using financial, technical, and clinical workgroups that enabled administrators, physicians, and outside consultants to agree upon and operationalize technical as well as data standards.…”