Hospital-Backed HIE On The Rocks

In an all-too-familiar tale of conflict, turf wars and financial doubts, a three-year effort to bring some of the Chicago area’s largest hospitals into an HIE seems on the verge of collapse.

The proposed HIE is backed by the Metropolitan Chicago Healthcare Council, a nonprofit group of about 150 hospitals and healthcare providers. But despite industry backing, the effort hasn’t gotten any momentum. Though the Council has been flogging the HIE concept since 2009, just 18 hospitals and physician groups have agreed to join, according to a report in Crain’s Chicago Business.

In theory, the massive, sophisticated health systems that serve the Chicagoland area would see the value in sharing medical records if anyone would. If nothing else, they’re doubtless thinking about or already participating in risk-bearing ACO contracts, so cutting down on needless duplicated tests would be a plus.

But apparently, potential HIE members are balking at the cost of sustaining the HIE, which can run to six figures annually depending on the institution. Apparently, they’re not sure that they’ll get a decent return on their investment. And of course, there’s little doubt that these systems are already investing many, many millions in EMRs and supporting systems, tying up most if not all of their IT investment budget.

What’s more, while Crain’s doesn’t mention this issue, I’d argue that hospitals are also skittish about cooperating with their competitors. Particularly in an intensely competitive market like Chicago, hospitals and health systems may feel that HIEs are a step too close to the enemy.

Now, even if the major hospitals refuse to invest in the HIE, the Council does have other ways that it might be able to pay for the exchange.  For one thing, the group has begun discussions with health insurers to see if they might be interested in helping to fund it. And there’s always government grants, which are available to help kick off startup HIEs.

The bottom line, though, is that hospitals are still conflicted when it comes to HIE involvement. Though most CIOs say that they’re interested in being involved, financial — and let’s not forget competitive — issues prevent them from getting on board.

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.


  • I remind myself frequently that in many hospitals and practices, the bottom line, and the perceived loss of business that MIGHT happen when one shares medical records with other practices and hospitals can easily cause them to not join or support a HIE. This short sightedness ignores that data flows 2 ways, PLUS record sharing might just save some patients’ lives, or lead others to a better outcome, as well as reducing waste on repeated tests or delayed or messed up treatments coming from lack of access to patient data.

    This makes me question the whole, voluntary aspects of HIE participation in MU; sharing of data should be at the top of the MU list!

  • I think it’s mighty presumptuous to assume that the financial doubts hospitals have in participating in a public HIE lie in their desire to preserve competitive advantage vs area hospitals.

    There are several logical factors to consider when discussing whether public or non-private HIEs are financially sustainable and never have I read nor seen (until now) free market competition listed as a concern. The doubts of expiring government HIE grants, unfair HIE membership/subscription models that favor small hospitals over larger systems, and a growth of private HIEs and ACOs are all more logical explanations for why this, and other, subscription-based (public) HIEs have doubters about their long-term sustainability.

    Discussing public HIE sustainability is straightforward enough. Perhaps the more powerful discussion lies in: Who owns the data? Through Meaningful Use’s mandate that providers demonstrate health data exchange with external, unaffiliated organizations the answer is clear: the data belongs to the patient.

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