Health Information Exchange (HIE) Concepts

Key Benefactors:
Patients – quality of care, unified health record, convenient access to information.
Physicians – access to patient information.
Insurers, Medicaid, and Medicare – reduction of fraud, abuse, and duplication of service.
Pharmacies 

HIE Characteristics:
HIE has characteristics of an infrastructure intensive utility. ( Roads, interstates, electric grid, internet ) For rapid deployment of an infrastructure intensive utility, history has shown that the government must provide initial funding, direction, and regulation.  Several factors exist with HIE that will require this. It is expensive, not as much as an interstate, but more than initial users will fund.  The physicians that will add value (information) to HIE are not the primary beneficiaries and will not embrace a policy that burdens more than it benefits. ARRA has already provided for some initial federal funding for HIE, but assistance at the state level, direction, how it will regulated, and sustained though future revenues have yet to be resolved.  If history holds true, for long term success, HIE will need to be heavily regulated in the beginning then tapered back once HIE matures and is able find its own best direction.  Policy will need to encourage and nurture providers that add value to participate.  Effectiveness and value of an HIE is directly proportional to provider participation, and funding strategies should reflect this.

HIE Funding:
Consider a credit based funding system similar the carbon credit system already in effect.  Practitioners and hospitals would get credits for adding records to the exchange and use credits to pull information.  Those with excess credits could sell them back to others on the exchange.  Policy and regulation would determine credit exchange ratios and credit price.  Example: 1 credit is worth $10.47 and practitioners get 1 credit for posting a record to the exchange and use 3 credits to pull one record.  The credit exchange ratios and prices could be changed to assist with funding.  The goal of setting these ratios and prices should be to make the cost to practitioners who add the greatest value and information to the exchange have to pay little or nothing to use it.Insurers, Medicaid, and Medicare pay a fee for limited access to exchange records and data just to determine fraud, abuse, and duplication. Privacy concerns should be addressed by policy. Although a combination of government and private sector, payers are the single largest financial beneficiary of HIE, contribute nothing to the exchange and should bear the greatest funding burden.  Indirectly the insured and taxpayers will benefit through reduced cost.  Patients can have seamless and easy access to their patient information.  This could be offered at no cost or on a free limited or paid subscription plan similar to how credit reports are now available to the public. State HIEs should receive support and funding for direct participation in a national HIE.

Selected Key Stake Holders:
Practitioners and hospitals as key stake holders stand to pay more and benefit less than any other stake holder.

EHR Vendors must comply or die.  With respect to the relationship between meaningful use and HIE, EHR vendors will need to provide an interface that meets content requirements, and translates information in a way that can be received and understood by the exchange. This stakeholders goal could be to make initial meaningful use requirements simple or limited in scope with the possible exception of attempts by market dominators to increase interface requirements in an attempt to drive competition out of the market. Practitioner and hospital organization should explore similarity with EHR vendor to identify similarity, combine efforts, and unify messaging to influence policy.

Conclusion:
Hospitals and physicians associations Healthcare providers and suppliers should immediately increase efforts and expand involvement with current HIE initiatives.  This will better position practitioners to shape the action on how HIE will be funded and sustained in the future.  Failure to engage effectively now may result in less than favorable funding and participation requirements in the future.

Author: Sam Estridge, COO, CFO CAROLINAS IT
Contributing Editor: Lori A. Harrington, BBA, MHA