Delivering on the Promise of HIEs

Health Information Exchange (HIE) is a key component in the move toward meaningful use of electronic health records. Because working with an HIE is relatively new to many in Public Health, there are a number of questions surrounding it. One of the biggest involves how the state’s HIE will support public health needs for the collection and monitoring of healthcare data. This data can include syndromic surveillance data, notifiable condition data, immunization, health registries, or other unique projects.

That is a tough question. To answer it, we need to fill in the landscape a little bit.

Going back to 2006, Health Monitoring Systems (HMS) completed a study of existing functional health information exchanges. At the time, they were referred to as RHIOs – Regional Health Information Organizations. We undertook the study with the expectation that EpiCenter, our Syndromic Surveillance system, would need to work—from day one—in concert with the evolving RHIOs.

To our great surprise, we found that only two RHIOs nationally were viable and functional. Our research wasn’t exhaustive but it involved an active search for functional, self-sustaining RHIOs.


So What Happened?

The big question then (and now) is why HIEs/RHIOs haven’t thrived. The benefits of exchanging healthcare data seem obvious. In our research, Dr. Andrew Walsh was able to demonstrate time savings, improved care, and financial savings associated with HIE use.

Despite these proven benefits, undefined costs remain—notably, who pays for the HIE?

The American Recovery and Reinvestment Act (ARRA) provided funding for HIE creation. Along with the standards supported through ONC, two substantial barriers have been lowered.

The jury is still out on whether the result will be a long-term, financially viable health information exchange.

Public Health Dilema

Public health has a need for data, and that need is constantly growing—from monitoring current health conditions to event response and measuring the effectiveness of public policy.

The promise of HIE was that it would lower the burden on public health for data collection while improving the range of data available. It has yet to deliver.

On a positive note, the promise of HIE has forced public health to collaborate and support the HIEs. But short-term issues still remain.


HMS fully supports the overall vision of HIE. We are anxiously awaiting the opportunity to provide our clients with access to a wider range of data. But the possibilities for improving the delivery of healthcare through IT cannot be fully realized until HIE is ubiquitous throughout the country.

Until then, we strongly recommend that public health engage the state HIE in a pragmatic way:

Realize that the two primary goals of the HIE are to achieve long-term financial viability and demonstrate short-term benefit. These two goals may be in conflict over time, as available funding is reduced for the HIE.
Create well-defined, tightly scoped demonstration projects that evaluate the feasibility of using the HIE for data access
Develop technical and administrative relationships with the HIE to ensure that the public health IT roadmap and the HIE roadmap are compatible
Keep HIE success off of the critical path for urgent data collection projects—until all of the kinks are worked out technically, politically, and financially.

For syndromic surveillance, we recommend engaging the state HIE in a demonstration project that includes data collection from a small number of facilities. The project could provide redundant data through the HIE while taking advantage of the greater breadth of surveillance data available through the HIE. A demonstration project benefits both public health and the HIE, while revealing potential problems for more critical, longer term, and complicated engagements.

Most importantly, it supports the long-term vision and need for effective health information exchange and starts the engagement out on a positive note.