Study Suggests Most HIEs Aren’t Sustainable

According to an EHR Intelligence piece, most HIEs spend more than $1 million per year on operational expenses. That number is probably well on the low end for regional HIEs with multiple health system partners. All told, I think we can agree we’re talking about a money pit here.

The question is, and has been for many years, whether those investments offer any financial or clinical payback. After all, you can only lay out that kind of money for so long before there’s no business case for the exchange.

Unfortunately, it looks  like the answer may still be “no” in many cases, according to the authors of a study appearing in Perspectives in Health Information Management.   Of the 96 HIEs that responded to the researchers’ survey, the “vast majority” didn’t have a business model in place that would sustain itself even into the near future.

What’s worse, there’s little evidence that things are due to change anytime soon, the authors write:   “The last decade has seen significant progress in HIE technologies and substantial investments in HIT adoption, yet the lack of evidence on the value delivered by such efforts remains a major hurdle in making a strong case for both adoption and investment at the local level.”

Even more troubling is the apparently lack of insight into this state of affairs by HIE leaders, the authors assert.  When asked how they measured ROI, the authors apparently got very squishy answers, such as that they “believed” their HIE was showing positive ROI without having any metrics to make this case.

I don’t know about you, readers, but I’ve been following health data exchanges of various kinds since the early 1990s, and this is just depressing. If the government’s strategy in doling out some HITECH dollars to HIEs was to help build the core of the Nationwide Health Information Network, I think it’s pretty much proving to be a bust.

No, I’ll come out and say it:  I think the government ought to pour massive funding into building out the NHIN and just get it over with without waiting for the politics and competing priorities of healthcare to gum up the works. At this point, I doubt anything else CAN work.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.


  • Ask the Brits how it works to have the government pump billions into HIE.
    The solutions will grow from the bottom-up and not the top-down. I am very optimistic that the Direct Protocols and REST approaches will supersede a lot of the current hubris. Also, once the information can be truly patient-centric, we will finally overcome many of the current obstacles.

  • I know that a lot of people today don’t want the ‘government’ running healthcare. Fine. Don’t have a government agency run the Health Exchange networks. But government can sponsor a national network with an alternate patient identifier (other then SSN) for health information exchange. Government pays (perhaps via a tax) and hires one or more contractors (sounds like how CMS works) to work together. If individual HIE’s or equiv wnat to stay around, they can join – and meet national standards.

    I say this because doing this a few practices and hospitals at a time (look at Long Island) doesn’t work. EHR vendors don’t know what standards to meet and most don’t have the resources to meet several different standards loosely based on HL7.

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