The Number Of Health Information Exchange Efforts Is Declining, Leaving The Viability Of Broad Clinical Data Exchange Uncertain

Abstract

The diffusion of health information exchange (HIE), in which clinical data are electronically linked to patients in many different care settings, is a top priority for policy makers. To drive HIE, community and state efforts were federally funded to broadly engage providers in exchanging data in ways that improved patient care. To assess the current landscape, we conducted a national survey of community and state HIE efforts soon after federal funding ended. We found 106 operational HIE efforts that, as a group, engaged more than one-third of all US providers in 2014. However, the number of operational HIE efforts is down from 119 in 2012, representing the first decline observed since the tracking of these efforts began in 2006. Only half of operational efforts reported being financially viable, and all efforts reported a variety of barriers to continuation. These findings raise important questions about whether the current vision for HIE efforts will allow for the broad exchange of clinical data, or whether alternative approaches would be more successful.

�The Doctor Needs to Know�: Acceptability of Smartphone Location Tracking for Care Coordination (Preprint)

“…The inability to transfer clinical information between organizations remains a persistent barrier to care coordination, as evidenced by a recent decrease in the number of operational HIEs [9] and the challenges primary care practices face in using health IT to coordinate emergency and inpatient care [4]. Our findings seem to align with those of a prior qualitative study, in which consumers expressed willingness to make tradeoffs between privacy and security if a mobile health (mHealth) intervention offered increased convenience or benefits [23].…”

“…Electronic health records (EHRs) are often unable to facilitate care coordination between organizations [4,7], and less than half of U.S. hospitals [8] and providers [9] participate in an operational health information exchange (HIE). While interventions that prioritize care coordination-such as disease management and transitional care programs for chronically ill patients-have reduced hospital admissions [10][11][12] or improved patient-reported outcomes [11,12], their replicability and scalability are limited by a lack of global cost-savings [10,13].…”

A population ecology perspective on the functioning and future of health information organizations

“…The previous decade witnessed the peak popularity of community HIOs with several hundred in existence (Adler-Milstein et al, 2008). After this peak, organizational mortality appeared to rise and current estimates indicate that approximately 125 community HIOs are in operation (Adler-Milstein, Lin, & Jha, 2016). Additionally, ,the conceptual shift in the early 2000s from the siloed information systems of electronic medical records to the information accessible, interoperable EHR model, propelled EHR vendors into the business of moving information.…”

Key Factors Affecting Ambulatory Care Providers’ Electronic Exchange of Health Information With Affiliated and Unaffiliated Partners: Web-Based Survey Study (Preprint)

“…Despite such benefits, HIE usage has been low among ambulatory care providers [11][12][13][14]. In contrast to 76% hospitals who used HIE in 2014, only 42% of ambulatory care physicians engaged in any kind of HIE -within or outside their system.…”

“…To enhance HIE usage, providers need to effectively incorporate HIE into current workflows and routines [25]. Workflows tend to differ across practice settings [23], and fusing them with HIE can be challenging [11]. Integrating HIE into current workflows can be achieved by (i) tweaking and redesign of existing workflows, or (ii) customizing the HIE-related information systems to fit in with the clinic-specific workflows.…”