Report: Future Growth and Sustainability is Biggest Challenge for HIEs

The Washington, D.C.-based eHealth Initiative (eHI) released its 2011 Report on Sustainability entitled, Health Information Exchange: Sustainable HIE in a Changing Landscape. The report indicates future growth and sustainability remains the biggest problem for HIEs.

This report builds on the 2011 HIE survey results which indicate that at least 255 communities across the U.S. are continuing to bring together multiple stakeholders to focus on the secure exchange of health data to improve health and outcomes for patients. Such efforts bring all stakeholders within the health system, including clinicians, community health centers, consumers, employers, health plans, hospitals, laboratories, pharmacies, public health agencies and government together to streamline data delivery between patients and providers.

Out of the 196 initiatives that responded to the 2011 survey, 24 (12 percent) reported being self-sustaining. This indicated a 33 percent increase in sustainable initiatives over 2010, in which 18 sustainable HIEs were identified.

As in 2010, and consistent with findings from previous and current HIE reports, developing a long-term business model for future growth and sustainability proves to be the most difficult challenge for health information exchanges.

For those HIEs that were classified as sustainable, they continued to deal with issues common amongst a majority of HIE initiatives, such as organizational and governance issues; privacy and confidentiality issues with the exchange of personal health information; and technical issues, such as architecture, applications and connectivity.

Stakeholder involvement varies across the sustainable initiatives, but hospitals, primary care physicians and specialty physicians were primary stakeholders as both data providers and receivers for each of the 24 HIEs that were classified as sustainable, both from a governance and data exchange perspective. This likely reflects the expanded role associated with advanced HIE development and the capacity of these initiatives to offer services beyond simple data sharing amongst providers.

Those sustainable initiatives reported a number of mechanisms used to maintain funding within their program. In the results from the 2011 survey, 23 out of the 24 sustainable initiatives received funding from a primary customer, while a majority indicated that they charge hospitals and providers to participate in the exchange. Membership fees were noted as the most widely used revenue model for sustainability. Other initiatives received revenue from multiple stakeholders, mainly hospitals, provider practices and payers.

Additionally, while much of the discussion about what makes an HIE sustainable focuses on little or no reliance on federal funding to sustain HIE, it is not uncommon for sustainable HIEs to receive some money from the government. Of the 19 sustainable initiatives that reported the percentage of their revenue they receive from different revenue models within the survey, four indicated that a single model accounts for 100 percent of their revenue.

The remaining sustainable initiatives use a combination of different revenue models to create a sustainable business framework. The most common revenue model assesses membership fees on participating stakeholders. Ten initiatives include membership fees as part of or the entirety of their revenue stream. The eHealth Initiative began both tracking and supporting the efforts of multi-stakeholder efforts at the community level in 2003, recognizing the importance of not only national leadership, but also leadership at the local levels where care is delivered.