I had the privilege of presenting on health information exchange (HIE) this morning to Prof. Rema Padman’s Health Information Technology class. My goal was to put HIE in context, explain its history, challenges, and provoke discussion as to the future form of exchanging electronic health information.
When Congress allocated $35bn to support the adoption and implementation of information technology in healthcare, America made a down payment on promise of health information technology to increase the efficiency, affordability, safety, and quality of care of healthcare in America.
The result of that $35bn in HIT investment has been largely to transform silos of paper-based health information into silos of electronic health information. Electronic records have improved quality and efficiency within healthcare organizations, and possibly been a driving factor behind the consolidation that has characterized healthcare over the last decade. Much of the promise of health information technology remains out of reach, however, until such time that healthcare providers are meaningfully connected and exchanging health information.
Health information exchange addresses this need. Health information exchange is both the verb of (mass) exchange of health information between healthcare organizations, and also the noun for the entity (usually a non-profit entity, often with state or federal grant support) that provides the infrastructure and connectedness supporting such an exchange.
Health information exchange has many obvious benefits, but those benefits accrue primarily to patients and health plans (at present), and to the community and population (in the idealized HIE realization). As currently implemented and under current reimbursement schemes, healthcare providers seldom directly benefit form HIE (except to the extent that they value providing affordable, quality care), but are nonetheless expected to foot the bill for HIE (based on the currently popular business models for HIE entities).
I presented three (out of many) cases where HIE reduces costs or improves care:
- Reduction in duplictative tests and services
- Improvement in the quality of emergency care
- Reduction of preventable hospital readmissions
The takeaways from today’s talk:
- Health information exchange contains the potential to improve the quality and affordability of healthcare
- HIE faces considerable barriers to adoption, including gaining provider trust, matching provider incentives, and creating sustainable business models for the HIE organization
- Health Information Exchanges are one of many competing mechanisms for the exchange of health information. A decade ago, the Personal Health Record was the darling child of electronic health exchange. Today, the PHR is dead, and HIE is the current contender. HIE faces competition however, from direction (vendor mediated) connections, from upstart “HIE like” private companies aggregating pharmacy benefit and lab result information, and from future distruptions in the market.
There’s no guarantree of the future success of HIE. Although HIE has far greater adotpion than the PHR ever did, the future success of HIE depends on its ability to overcome obstacles to adoption, while silmutaneously increasding the quantity and quality of data available to its members through connections with laboratories, PBMs, and payers
The slides from my talk today are available below:
Click to download CMU Health Information Systems Presentation: Health
Information Exchange: Realizing the Promise of HIT