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Health information exchanges face an uncertain future, as new research calls into question their financial sustainability. Three characteristics are needed for the most success.
The question of whether health information exchanges will ever be self-sustaining has persisted for years — and now a new systematic review suggests that most are not.
Research conducted by Rand Corporation, in fact, took a closer look at HIE clinical care, cost and usage data from 2003 through 2014. After poring through the details and findings of 85 studies related to HIE, Rand highlighted several discoveries.
Perhaps chief among those: Despite the $600 million of federal funding allocated to support HIEs, most of them are facing hard times, viability-wise. Rand officials noted that out of 17 sustainability studies examined, only 25 percent considered themselves financially sustainable.
"Many HIE organizations still struggle to find a value proposition," Robert Rudin, associate policy researcher at Rand, and his colleagues, wrote in the review.
One of the things Rudin and his colleagues noted was that three characteristics appeared to be associated with the more financially viable HIEs: ambulatory physicians who received data; data-receiving hospitals and receiving payments from participants.
Those organizations without these three cited serious barriers to progress.
"Although most stakeholders believe that HIE will be valuable to healthcare, particularly in terms of quality and efficiency, there are many barriers to adoption and use, and these vary somewhat by stakeholder," Rudin and colleagues wrote.
For clinicians, these barriers are related to interrupted workflow, interface woes, technical setbacks and even cost.
Hospitals and large provider organizations, on the other hand, have a different set of concerns. They cited lack of a business case, lack of standards and legal/ethical matters.
And for patients? It all came down to privacy.
Researchers were also sure to underscore the cost savings derived from HIE data as well, which showed considerably more promise, something that certainly can't hurt the business case. In some reports, HIEs were associated with big-time savings.
One study, for instance, highlighting the experience of the MidSouth eHealth Alliance in Tennessee, showed that the HIE resulted in a significant decline in readmissions that catalyzed net savings of $800,000 across 11 hospitals.
For HIEs overall, though, researchers called the cost savings evidence "low-quality." And, as far as the ability of HIEs to produce quality outcomes and satisfaction, the jury is still out.
"The effects of HIE use on other outcomes (quality or satisfaction) and in other settings (hospital or office) have been insufficiently evaluated to draw conclusions," Rudin and colleagues explained.