A recent study from the Office of the National Coordinator for Health IT shows health information exchange between hospitals and other providers has jumped 41 percent since 2008. In 2012, 58 percent of hospitals were exchanging patient information with providers outside of their organization, a rate that is projected to rise as the healthcare industry prepares for meaningful use stage 2.
However, many providers are hesitant to invest financially in HIEs, as demonstrated by a report released by the Robert Wood Johnson Foundation. A survey of 119 HIEs found 74 percent to be struggling in the development of a sustainable business model, and 66 to be facing a lack of funding. The source of many of these struggles was found to be providers hesitant to support HIE efforts "without a clear sense of timing or the likelihood of benefits," according to the RWJF report.
To Scott Fowler, JD, MD, this is the wrong mentality. HIEs have to be a community effort.
Dr. Fowler is the president and CEO of independent physician practice Holston Medical Group in Kingsport, Tenn., and president of OnePartner HIE, a physician-owned HIE that connects more than 700 regional physicians from 14 physician practices. The practices use a variety of electronic health record platforms and are affiliated with different hospitals, but they are able to find and share patient information on the common exchange. Cumulative data on each patient can easily be extracted by a physician immediately, providing the physician with the necessary information to devise a treatment plan.
"You need to be able to look at the whole [healthcare] community and see every place the patient has been seen" to be able to devise the best course of action for the patient's care, says Dr. Fowler.
Data exchange can also help reduce costs for all providers involved in the patient's care, both by eliminating duplicate tests and services and curbing administrative costs involved in transmitting patient records, as "the alternative [to getting data from an HIE] is to ask a nurse or office assistant to get the records from another provider," says Dr. Fowler. Additionally, "trying to get a patient’s record the same day can be tricky — it often involves faxes," and is a barrier to efficient care delivery.
Dr. Fowler sees HIEs as "critical" to physicians' workflows and a necessary step to providing a continuum of care for the patient. He also knows the cost of the technology often keeps many physicians faxing record printouts. "HIEs are expensive," says Dr. Fowler. "If you're trying to make one for a group of less than 200 or 250 doctors, it's probably prohibitively expensive."
Because of both the high costs and the ability for HIEs to improve care delivery for all involved, especially in an increasingly value-focused industry, Dr. Fowler believes HIEs should be a community effort. Bringing more providers into the HIE implementation efforts will allow economies of scale to bring down the cost for all participants as well as increase the value of the exchange by increasing the amount of available data.
"From a hospital's point of view, it's well worth the time and energy it takes to create an HIE model that brings costs down for other providers" so outside physicians can join, says Dr. Fowler. "The goal of this is to accumulate data for the purpose of patient care, it's not a system designed to create profit."
OnePartner was originally set up for 600 physicians to keep per-provider costs down, and all the providers have benefited from the large upfront cost to the community, says Dr. Fowler. He expects to have the region's two major hospitals connected to OnePartner within a year or two, and to keep expanding.
"In the future, HIEs are the closest thing we're going to have to a universal language" in the healthcare industry, says Dr. Fowler. He sees the community approach as inevitable as hospitals and other providers realize the value, even in the absence of immediate cost savings, of HIEs.
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