Health Information Exchanges

Health information exchanges are supposed to facilitate the exchange of information among providers, payers, patients and others in the health system.  The federal government has attempted to encourage creation of something called the Nationwide Health Information Network, but not much has really happened.  There are also a variety of state and private data-sharing initiatives.  A couple of recent articles discuss aspects of these initiatives.  The first, published in the Journal of General Internal Medicine, was based on a survey of consumers about physician use of HIE and interest in using HIE themselves.  It was conducted among consumers in the Hudson Valley region of New York, an area with a number of HIE initiatives.   (JGIM Article)

About 60% of the respondents said their doctor used a computer in their care and 79% said they used the internet at least once a month.  Almost half of the respondents who received care from multiple providers said communication between them was suboptimal.  Two-thirds of respondents wanted their providers to use HIE, largely because it would improve communication among providers and increase the accuracy and completeness of medical records, and 58% said they would use a computer to help manage their care.  The second article is in the Annals of Internal Medicine and was an assessment of the state of various HIE efforts.   (Annals Article)

The authors focused on Regional Health Information Organizations as the most viable method of encouraging widespread data sharing.  They surveyed all possible RHIOs to ascertain status and viability.  They found 75 operational RHIOs which covered 14% of hospitals and 3% of physicians.  Only 13 of these supported functionality that would be consistent with providers’ obligations to make meaningful use of HIE.  Almost all the RHIOs were not financially viable, which means that they generated sufficient revenue to cover their operating expenses.  It is apparent that we are a long way from having any kind of government sponsored HIE infrastructure.