Why Are HIEs So Scarce?

By Katie Wike, contributing writer

Despite offering a number of benefits - and being cited as critical to improving care - HIEs have not caught on as quickly as many expected.

“While the sharing of information electronically (or health information exchange) plays a critical role in improving the cost, quality, and patient experience of healthcare, there is very little electronic information sharing among clinicians, hospitals, and other providers, despite considerable investments in health information technology (IT) over the past five years,” explains Health Affairs.

One study found HIEs reduce redundant testing and save hospitals money. Another says using an HIE cut emergency room admissions by 30 percent in New York. A Frost & Sullivan report called HIEs critical to healthcare integration.

But why, if health information exchanges are such a positive influence on care, are they still scarce?

According to Government Health IT, despite more than $26 billion being spent on HIEs - much of that through incentive payments - only a small percent of providers participate in exchanges.

“Because most payment in the US health care system today is volume-based versus outcomes or value-based, there is little financial incentive to share information across settings to reduce costs or improve the quality of care,” Janet Marchibroda, director of the Health Innovation Initiative and the executive director of the CEO Council on Health and Innovation at the Bipartisan Policy Center (BPC), wrote in Health Affairs.

“The significant increase in adoption of new models of delivery and payment across the United States as well as penalties for hospital readmissions implemented by CMS are expected to expand the business case for interoperability and information sharing. However, so far these new models of care have relied upon old models of information sharing, including the use of phone, fax, or mail, or siloed information-sharing networks.”

According to experts like Marchibroda, HIEs are hindered by the nature of the healthcare market where patient data stays where care is delivered. This includes primary care offices, specialists, and laboratories. But the situation is improving, according to an ONC brief issued in May which indicated 6 in 10 hospitals exchanged information outside of their system.

“The U.S. healthcare system is undergoing significant change in response to concerns about rising healthcare costs and uneven quality,” Marchibroda wrote. “Innovative strategies associated with care delivery, payment, and engagement of individuals are rapidly emerging to address these challenges, but such strategies must rely on information sharing across the healthcare system to be successful.”