New Report Identifies Strategies for Health Information Exchange Success, Sustainability

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The National e-Health Collaborative Aug. 2 released a report featuring case studies of 12 sustainable, mature health information exchange organizations from across the country, and their strategies and lessons to succeed in HIE.

Top suggestions for a successful business model include collaboration with insurance companies, flexible governance structures, and exploration of new revenue models, according to the report.

The report, Secrets of HIE Success Revealed: Lessons from the Leaders, was developed based on interviews with senior executives from 12 HIEs. NeHC profiled these HIEs based on their innovative strategies and business models, the value and impact they have had in their respective communities, and their maturity in achieving sustainability, the association said.

“With a new environment of increasing accountability in health care, the need for effective, sustainable HIE to improve quality, care coordination, and cost-effectiveness is becoming even more important,” Kate Berry, chief executive officer of NeHC, said at a press briefing on the report. “This report distills the critical dimensions required for a successful and lasting HIE operation and is intended to contribute to a cohesive national roadmap for nationwide HIE.”

Critical success factors identified by the 12 participating health information exchange organizations included:

• aligning community stakeholders with HIE priorities;

• establishing and maintaining a consistent brand identity and role as a trusted, neutral entity committed to protecting the interests of participants;

• pursuing initiatives that best addressed common needs of the HIE and featured a value proposition strong enough to support the goals of all participants in the HIE; and

• understanding clinical workflows and managing change.

The 12 health information exchange organizations featured in the report were Availity, based in Jacksonville, Fla. and serving the state of Florida; Big Bend Regional Health Information Organization in Tallahassee, Fla.; HealthBridge in Cincinnati; HealthInfoNet, based in Portland, Maine, and serving the state of Maine; Inland Northwest Health Services in Spokane, Wash.; MedVirginia, based in Richmond, Va., and serving the state of Virginia; Quality Health Network in Grand Junction, Colo.; Rochester RHIO in Rochester, N.Y.; Sandlot, based in Fort Worth, Texas, and serving North Texas; SMRTNET, based in Oklahoma City, Okla., and serving the state of Oklahoma; THINC in Fishkill, N.Y., and serving the Hudson Valley; and the U.S. Department of Veterans Affairs.

All of the organizations featured in the report offer the basic HIE services of collection, management, and distribution of patient health information, delivery of patient clinical care summaries, and connectivity to electronic health records, NeHC said.

Sustainable Business Models

Each organization found success through a unique business model that reflected the local, community-based nature of health care, Berry said.

For some HIEs, a business model that required hospitals, physicians, and other providers to pay fees, usually subscription fees, proved successful. For other organizations, sustainability was achieved through health plans and other data suppliers such as labs paying fees based on patient size and volume, according to the report.

In some cases, payers contributed most of the operating expenses with additional revenue coming to the HIE from data suppliers. Additionally, some organizations separated grant funds from operations costs and used state and federal grants to finance new strategic initiatives, the report found.

According to the report, several of the HIEs believe that using participants in the exchange, such as health plans and physician practices, as a source of revenue is essential to the long-term sustainability of the HIE business, and that positive outcomes like reduced data distribution costs and increased staff productivity are the major reasons why participants are willing to pay for the HIE services.

Future Plans

Looking forward, raising capital to steadily grow is key to long-term sustainability, the report said.

Furthermore, as an HIE grows, its stakeholder community becomes more heterogeneous, making governance more challenging and complex, the report found.

Leaders of the HIEs asserted they have the governance structure in place that is needed for the long term, and lessons learned from the profiled HIEs suggest that establishing a stable yet adaptable governance structure early in the HIE's lifecycle is a key indicator of future sustainability.

The report is available at http://nationalehealth.org/SecretsofHIESuccessRevealed.pdf .