Health care reform is driving accountable care organizations that compel patients to be more active in managing their care and for providers to offer tools to aid patients. But few health information exchanges have yet gotten the message, according to an annual status survey of HIEs.

Advocacy organization eHealth Initiative, in its 10th survey, identified 315 HIEs--compared with about 300 last year--and 199 responded to the 2013 survey. About half are regional HIEs with the rest almost split between state-operated entities and private HIEs for delivery systems. Only 31 of the HIEs enable patients to access their information, 24 enable patients to make appointments, 26 offer them educational materials and 25 support medication refill requests. While 102 HIEs plan to offer patient access to their own data, 56 others do not.

Many HIEs also are not exchanging data with providers outside of their network. Thirty-three restrict access to entities within the network and 58 have not connected with other HIEs. But connectivity issues continue as a major hurdle for all HIEs with respondents wanting standardized pricing and plug-and-play integration from vendors, and better use of data, vocabulary and transport standards among providers. Sixty-eight responding HIEs report having to connect to more than 10 disparate information systems, with one-fifth building interfaces for more than 25 systems.

For your consideration: Profiling HIEs in a Rapidly Changing Environment

There are bright spots in the eHealth Initiative survey of health information exchanges. More are improving financial viability with 52 getting sufficient revenue from participants to cover operating expenses. While only 16 HIEs reported being financially sustainable in 2011, 35 were sustainable this year. Fifty-one non-sustainable HIEs either receive more than half of their money from federal funds or are state-designated HIEs.

Exchanges may be lagging in supporting patient access to data, but they have ramped up functionality for providers in the era of health reform. Common services include a master patient index, results delivery, care summary exchange and secure messaging using Direct Project protocols. Now, HIEs are targeting new services toward data analytics, clinical alerts, image exchange, connectivity with other networks, and expanding patient access to their data. In particular, survey authors believe that analytics offers HIEs the long-sought opportunity to demonstrate their value.

A report summarizing survey results is available here; brief registration is required.

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