Progress on e-health exchange efforts

Emerging efforts to build electronic health information exchanges around the country have made significant strides over the past year toward becoming "fully operational" but still must address major hurdles to ensure long-term survival, according to a recent report by the eHealth Initiative.

In a survey of health information exchange collaborators, the Washington, D.C.-based public-private collaborative asked HIE organizers to self-report their progress against a criteria composed of six stages of development. Sixty-five or 60% of the 109 respondents in 45 states and the District of Columbia reported that they are in advanced stages of development. Of those, 40 reported that they are in the implementation phase and 25 are or expect to be "fully operational" within six months, up from nine in 2004.

As defined by the eHealth Initiative, "fully operational" exchanges are those in which disparate health care organizations are transmitting at least one clinical transaction among themselves.

"I'd say there's been substantial progress" based on the fact that exchanges that are in the implementation or operational phases had to overcome social and cultural barriers to reach those stages, said J. Marc Overhage, MD, CEO of Indiana Health Information Exchange, a nonprofit exchange in Indianapolis. These types of barriers are the toughest to get past, because it requires competing organizations to cooperate with each other, Dr. Overhage added.

Another reason for progress is that a year ago, exchanges were characterized by "lots of energy and enthusiasm, but this year there's actually work getting done, organizations being created and concrete decisions being [made]," Dr. Overhage said.

In 2004, a number of health information exchanges sprouted up after the Bush administration announced its goal of implementing, by 2015, a national health information network, with local, community, regional and statewide health networks emerging as a key building block.

Despite the advances being made, observers acknowledge that initiative organizers will confront significant challenges to survive, particularly since many of them rely heavily on federal grants to fund start-up costs.

"There is enormous momentum out there ... [but] in order for this work to continue, we need to find sustainable [business] models for health information exchange," said Janet M. Marchibroda, eHealth Initiative's CEO. "I think that we're at a critical point in time over the next couple of years, and unless we crack that nut ... we risk that not happening."

The exchanges themselves acknowledge this assessment. Ninety-one percent of survey respondents said securing funding to support start-up costs and ongoing operations is their greatest challenge. The next greatest challenges are developing a sustainable business model (84%), linking patient data (80%) and engaging health plans (74%).