Some $548 million in the HITECH Act was devoted to offering startup funding to HIEs, which have helped to fill gaps in EHR interoperability. But that money is set to run out by the end of the year. “The health care providers are not willing to pay for the service at the level needed,” said Adler-Milstein. “They don’t see enough value, and that’s because much of it doesn’t accrue to them. It goes to patients and to health insurance companies. The central challenge is that the incentives and the business model are not aligned yet for this to really work.”
In an additional update to the challenges being faced by HIEs, the latest report from the Robert Wood Johnson Foundation (RWJF) indicates that participation in Operational HIE efforts is low among public health departments, and that public health reports were the least common type of data exchanged:
Test results were the most common type of data exchanged (82% of efforts). The next most common type was patient summary care records (exchanged in 79% of efforts). Discharge summaries were the most common type of data exchanged from inpatient settings (66% of efforts) and clinical summaries were the most common type of data exchanged from ambulatory settings (61% of efforts). Public health reports were the least common type of data exchanged (occurring in only 30% of efforts).
The RWJF report also noted that “The two public health-related stage 1 meaningful use criteria (syndromic surveillance and reportable lab results) were least likely to be supported by the HIE efforts. A small subset of HIE efforts supported all six HIE-related meaningful use functionalities.”
So what will happen in January when the funding runs out? Ideally leaner, more efficient alternatives to HIEs will find an approach that ensures that all stakeholders who benefit from health information exchange pay to support it. “In particular,” said Adler-Millstein and her colleagues, “efforts to exchange health information need to better engage private payers.”
Image Source: Health Information Technology in the United States: Better Information Systems for Better Care, 2013