Even with the infusion of nearly $600 million via the HITECH Act to help states offer statewide health information exchange between providers, payers and other stakeholders, financial sustainability remains the biggest challenge of state and regional HIEs, authors of a new report published on July 8 conclude.

Concerns with HIE is one of several health information technology issues examined in the 2013 edition of an annual status report, “Health Information Technology in the United States,” from the Robert Wood Johnson Foundation. Other chapters cover progress on electronic health records adoption, mitigating disparities in EHR adoption, improving patient education with EHRs and comparing U.S. HIT adoption with other nations. The foundation sponsored the report with research done by Harvard School of Public Health and Mathematica Policy Research.

Tackling HIE sustainability is particularly important now as federal funding winds down during 2013. Providers in large part have not been willing to pay for HIE and insurers haven’t substantially supported such efforts, according to the report. “The hope is that forces beyond HITECH will help promote HIE and create a stronger business case. In particular, new approaches to the delivery and payment of care, such as Accountable Care Organizations, could increase demand for HIE and related services.”

Report authors identified 221 organizations engaged in HIE efforts and surveyed them between August and November 2012, getting responses from 172. From the 172 respondents, 119 were deemed operational HIE efforts that were actively facilitating exchange of clinical data between independent entities, and 53 were in the planning stage.

Survey results from operational HIEs found nearly 1,400 hospitals, or 30 percent of community hospitals, participated in HIE during 2012 compared with 14 percent in 2010. Seventy-five percent of the nation’s 3,146 hospital service areas had an operational HIE. Physician practice use of HIE was much lower, with 10 percent reporting participation in 2012 compared with 3 percent in 2010. Only 10 percent of operational HIEs supported six Stage 1 meaningful use measures for information exchange.

The survey found high levels of HIEs reporting various barriers to development, including financial sustainability, privacy and confidentiality concerns, government policies and mandates, technical issues, stakeholder competition concerns, and accuracy linking patient data. Report authors offer the following suggestions to make HIE more attractive:

* Ensure that Stage 3 of meaningful use substantially increases requirements for HIE to increase provider demand for such capabilities,

* Better engage payers in HIE by determining what is holding them back and designing appropriate policies, and

* The Office of the National Coordinator for Health Information Technology should immediately emphasize to states the need to identify sustainable business models. “While every state has a plan, the viability of these plans has not been rigorously assessed.”

The report is available here.

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