While health information exchange organizations are growing in maturity, they continue to face cost and technical challenges that remain key barriers to interoperability, according to the eHealth Initiative’s 2014 health data exchange survey.

The annual survey, which the eHealth Initiative has been conducting for the past 11 years, tracks the growth and progress of electronic health data exchange efforts across the United States. Of 267 identified HIEs, 125 respondents fully completed the survey—74 community-based HIOs, 25 statewide efforts, 26 healthcare delivery organizations—and an additional 10 gave partial responses.

“Overall, the data this year was pretty similar to what we’ve seen in the past couple of years,” said Alex Kontur, research analyst at eHealth Initiative, during a Web presentation of results. “On the technology side, we’re still seeing a lot of activity around interface development. Pretty much every organization that we surveyed has had to construct multiple interfaces with different EHR systems.”

Similar to the results of last year’s survey, HIEs continue to struggle with interface development as they work to stitch together disparate systems. In this year’s survey, 112 organizations reported that they have had to construct multiple interfaces, with 18 of them having constructed more than 25 interfaces.

Among the challenges to interoperability cited by survey respondents were: financial costs of building interfaces (74), getting consistent and timely response from EHR vendor interface developers (64), and the technical difficulty of building interfaces (48).

“Cost was the most frequently cited challenge to interoperability,” said Kontur. “Part of that has to do with the fact that the organizations owning the EHR or the HIE itself have had to bear the brunt of costs for interface development. We saw some misgivings being directed at vendors as 62 organizations want more standardized pricing and integration solutions from their vendor. And, a lot of others—54—want to see platforms that are better suited to use out of the box.”

Among the other key findings of the 2014 survey were:

*Regulatory policies appear to have prompted increased use of core HIE services such as Direct secure messaging, care summary exchange, and transitions of care;

*Advanced initiatives are supporting new payment and advanced care delivery models; and

*Sustainable organizations have replaced federal funding with revenue from fees and membership dues.

“The regulatory landscape, primarily through Meaningful Use Stage 2, has helped to define core HIE service offerings,” said Kontur. “For example, we saw a lot of growth in the use of Direct as a method of exchange.”

Three-quarters of respondents (101) revealed that they incorporate secure messaging into their data exchange models, 81 respondents reported that their users access data through secure messaging, and 78 respondents offer a Direct address directory.

In addition, 85 respondents in this year’s survey indicated that they have implemented notification/alerting services to support transitions of care—a 27 percent increase compared to the 2013 survey—while 108 respondents offered care summary exchange as a service, a 23 percent increase, and 74 respondents offer reporting to immunization registries (an 18 percent increase).

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