Despite the strategic importance of a health information exchange to facilitate a health care organization’s move to patient-centered accountable care, most health care providers—especially physician organizations—remain disconnected, isolated silos of information. Less than one-fifth of hospitals and only 3 percent of ambulatory practices are connected to an HIE, according to the Annals of Internal Medicine. A relatively small number of HIEs have attracted the critical mass of paying provider participants necessary to achieve a sustainable business model. Of the 73 operational HIEs in 2010, 14 percent had merged or ceased operations by 2011, according to data from the eHealth Initiative. These statistics suggest leaders at healthcare organizations around the country lack strategies for sustainable investments in HIE.         

Providers’ reticence to commit to an HIE is not surprising, considering the central role it would play to an organization’s care transformation efforts and the difficulties inherent in switching out a major infrastructure component if the strategy went awry. The HIE market’s nascent state coupled with the uncertainty of the financial viability of many HIE organizations raises the stakes of a healthcare organization’s decision to implement an HIE infrastructure, contributing to the inertia.

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