- A recent evaluation of the State Health Information Exchange (HIE) Cooperative Agreement Program found that national HIE use score increased from 36 percent in 2010 to 79 percent in 2014, but this figured was impacted by a small number of states significantly adopting HIE programs rather than more participation across all states and territories.
From 2011 to 2013, the number of directed transactions increased by a threefold and number of patient record queries increased by fourfold, the report stated.
A handful of states influenced the national numbers. For example, in Q2 of 2012, 85 percent of total directed transactions were from Indiana, Colorado, and New York. By Q4 in 2013, 5 states represented 85 percent of the total directed transactions.
According to the evaluation, the “gap between hospital-to-hospital and hospital-to-ambulatory care provider exchange also narrowed over the period—by 9 and 13 percentage points, respectively, for clinical care summary and laboratory results exchange.”
Care summary exchange from one hospital to another hospital outside of the system increased by 38 percentage points from 2011 to 2014.
In 2014, researchers found that 85 percent of eligible hospitals were reporting on at least one public health measure to the Medicare EHR Incentive Program.
In addition, 72 percent of participating Medicare professionals who vaccinate patients reported electronically to an immunization information system in 2014. This is a significant increase from 51 percent in 2011.
“Together, these results indicate a positive trend in HIE adoption and use, across the program years, states, and multiple services. Nonetheless, adoption and use varies heavily by state and many opportunities for expansion remain,” the report stated.
The Office of the National Coordinator for Health Information Technology (ONC) awarded a contract to NORC at the University of Chicago to perform an independent program evaluation of the State HIE Program. This program is part of the Health Information Technology for Economic and Clinical Health (HITECH) Act.
The HITECH Act was passed by Congress in 2009 to promote “the electronic movement and use of health information among organizations using nationally recognized interoperability standards.”
The ONC received $564 million from the HITECH Act to support development of HIE and electronic health record adoption across the United States. The State HIE Program was designed to help achieve HITECH Act goals by providing 56 states and territories with the necessary funding and guidance from the ONC to implement HIE systems over 4 years.
The program aimed to foster state-specific solutions for HIE. The report defined exchange as directed exchange (secure email or messaging), query-based exchange (information from a data set), or communication between EHRs. Each state was tasked with developing systems for exchange to increase system-wide interoperability.
The evaluation showed that states with state-led HIE programs were more successful with HIE adoption than true state designated entities (SDE) or SDE-like models.
States were faced with many challenges with implementing HIE and EHR systems. Many states had difficulty developing HIE infrastructure and services because the process was more resource intensive than originally anticipated.
Another challenge was that grantees experienced barriers with EHR developers and HIE vendors. Many of the developers and vendors were not prepared to deliver all the needs of HIE stakeholders.
The evaluation also reported that grantees wanted to see common standards and incentives for interoperability.
Overall, one of the biggest challenges that grantees faced was sustainability.
“Grantees expressed concerns about the financial sustainability of their HIE efforts, wondering whether they would be able to secure the necessary financial investment to continue operating in the short term—needed to demonstrate long-term value to stakeholders,” the evaluation reports.
At the start of the program, the ONC provided funds to grantees. Since the program ended, states must find their own financial support to continue developing and using their systems. Some options may be healthcare payers, accountable care organizations (ACOs), and long-term care providers.
Since the end of the program, seven grantees are no longer operating.
“Our evaluation findings demonstrate that there is no one-size-fits-all solution with HIE; instead, development and use of HIE is predicated on the state and local environments within which it exists,” the report explained. “That said, certain factors influence HIE and are helping some states gain traction. These factors and exemplar states may serve as lessons learned for HIOs, grantees, and state and federal policy makers interested in continuing HIE development.”