The ehealth Iniative has released its most recent report on the status of health information exchanges, which are intended to facilitate the sharing of information on a patient which is generated or stored in multiple systems. Health information exchanges are a hodgepodge of government and private initiatives, which are not always well coordinated and which to date have a limited record of accomplishing their purpose. (HIE Report) The authors identified about 222 health information exchanges currently operating in the US, of which 161 responded to the ehealth survey. HIEs are fairly important to the achievement of care re-engineering efforts, including readmission reductions, accountable care organizations, medical homes, and bundled or global payments. All need the ability to share data, often in real time, if effective care coordination is to be achieved. The meaningful use requirements will also mandate some ability to share information.
Funding is a major problem for HIEs. Government may provide some initial startup financing, but the HIEs eventually need to find a method to charge users. The proliferation of public and private exchanges makes creating true interoperability more difficult and it is not yet clear that all the standards needed to facilitate exchange are in place and being followed. Another large barrier to creating value is provider mistrust of data generated elsewhere, including concerns about the accuracy, completeness and currency of data from sources outside a specific requesting organization. Most of the HIEs are non-profits; some are sponsored by provider organizations or private payers. All states have one HIE, but some have many, California for example has 22, which exacerbates the interchange of data problem. Most HIEs describe themselves as fairly far along in their development but there does not appear to be a huge amount of actual use of HIEs. As the demand for exchange grows, you have to wonder how we are going to simplify the current state of affairs so that there really is a single, easily usable method to access all clinical and administrative data on a patient.