Providers Still Have Hope For HIEs

Sometimes, interoperability alone doesn’t cut it.  Increasingly, providers are expecting HIEs to go beyond linking up different organizations to delivering “actionable” data, according to a new report from NORC at the University of Chicago. The intriguing follow-on to the researchers’ conclusions is that HIEs aren’t obsolete, though their obsolescence seemed all but certain in the past.

The study, which was written up by Healthcare Informatics, conducted a series of site visits and 37 discussions with providers in Iowa, Mississippi, New Hampshire, Vermont, Utah and Wyoming. The researchers, who conducted their study in early 2014, hoped to understand how providers looked at HIEs generally and their state HIE program specifically. (The research was funded by ONC.)

One major lesson for the health IT types reading this article is that providers want data sharing models to reflect new care realities.  With Meaningful Use requirements and changes in payment models bearing down on providers, and triggering changes in how care is delivered, health IT-enabled data exchange needs to support new models of care.

According to the study, providers are intent on having HIEs deliver admission, discharge, and transfer alerts, interstate data exchange and data services that assist in coordinating care. While I don’t have comprehensive HIE services research to hand, maybe you do, readers. Are HIEs typically meeting these criteria? I doubt it, though I could be wrong.

That being said, providers seem to be willing to pay for HIE services if the vendor can meet their more stringent criteria.  While this may be tough to swallow for existing HIE technology sellers, it’s good news for the HIE model generally, as getting providers to pay for any form of community data exchange has been somewhat difficult historically.

Some of the biggest challenges in managing HIE connectivity identified by the study include getting good support from both HIE and EMR vendors, as well as a lack of internal staff qualified to manage data exchange, competing priorities and problems managing multiple funding streams. But vendors can work to overcome at least some of these problems.

As I noted previously, hospitals in particular have had many beliefs which have discouraged them from participating in HIEs. As one HIE leader quoted in my previous post noted, many have assumed that HIE connection costs would be in the same range as EMR adoption expenses; they’re been afraid that HIEs would not put strong enough data security in place to meet HIPAA obligations; and they assumed that HIE participation wasn’t that important.

Today, given the growing importance of sophisticated data management has come to the forefront, and most providers know that they need to have the big picture widespread data sharing can provide. Without the comprehensive data set cutting across the patient care environment — something few organizations are integrated enough to develop on their own — they’re unlikely to mount a successful population health management initiative or control costs sufficiently. So it’s interesting to see providers see a future for HIEs.

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.


  • You nailed it in saying “interoperability alone doesn’t cut it”. Straight data exchange has proven insufficient to spur widespread adoption/use of HIEs. There are however many successful HIEs leading the charge to provide these follow-on services that do bring people in. Most of the HIEs I work with are already providing ADT alerts or are in the process of implementing the service. As you noted, that’s quickly becoming an expectation in their communities. Some are a step further offering additional services like: eligibility queries for local payors, analytics support (i.e. 30-day readmit tracking, basic population health stats, etc). For example, Main’s HealthInfonet launched a pretty comprehensive sweet of tools (

    Recently I’m seeing a lot of interest from HIEs who want to provide care coordination tools and quality measure reporting services to the communities.

    The strong HIEs get it. They’re going to expand their value added services on top of the base data exchange. As they do, the communities will rely on them more and more until they become the default way to do this work. That’ll start to sway the cost-benefit of orgs “rolling their own” and further spur adoption of the public HIE. HIEs are not obsolete… in 5 years they will be the primary method for interop.

    Related article I read yesterday about one HIE doing it right:

  • I have researched and written about HIEs for at least a decade, and for most of that time it has seemed that their efforts were futile. But market conditions have shifted, clearly. Thanks for providing your thoughts on the issue — they’re food for a future article!

  • Don Lee,
    Sounds like the perfect way to ensure a monopoly. If they are the central hub for data, then they’re in a unique position to offer some really great services. Seems like it will be important that we ensure that they don’t use the data that’s collected as a monopoly later in their evolution.

  • That’s a good point John. Admittedly I haven’t given that much thought. My hope is that the community oversight from sponsor organizations and user swill keep them in check. The group I’m closest with today very much has a culture of “Its not our data. Its the community’s data.” I hope that persists, but things do tend to change when power balances change. We’ll have to keep an eye on it.

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