Survey results indicate that health information exchange efforts are continuing to mature. Among the 165 HIE initiatives identified by the 2006 survey, 45 are in the implementation stage and 26 have identified themselves as fully operational. The primary focus of HIE efforts continues to be services that support health care delivery, with increasing interest and movement on services that support quality improvement efforts.
Increased maturity is evidenced by increased engagement by key stakeholders, the growing percentage of initiatives who are actually exchanging clinical data, and an increase in the number of stakeholders who are paying for health information exchange services. Significant advances have been made in the engagement of the diverse stakeholders in health care. Engagement of hospitals, health plans, employers, and primary care physicians is up considerably from 2005 levels with 96 percent, 69 percent, 54 percent, and 91 percent of respondents, respectively, now actively engaging such stakeholders in their efforts.
Health information exchange efforts are not just talking about delivering services, many are actually transmitting data. At least 20 percent of respondents are now transmitting a broad range of data electronically including claims, dictation, emergency department episodes, enrollment/eligibility, inpatient and outpatient episodes, laboratory results, and radiology results.
While the primary challenges of efforts continue to be those related to financing - both securing upfront funding and implementing a sustainable business model - increasingly health information exchange efforts are getting funding from those to which data services are provided. Based on this year's survey results, 24 percent of respondents are receiving funds from hospitals, while 21 percent are receiving funds from payers. Physician practices (16 percent) and laboratories (13 percent) are also serving as a growing funding source.
The use of health information technology (HIT) to improve the quality, safety, and efficiency of health care has been at the centre of recent federal policy changes, foremost in President George W. Bush's August 22 Executive Order calling for federal health care programmes to promote quality and efficient delivery of health care through the use of HIT systems that meet recognized interoperability standards. American Congress has also actively pursued the use of HIT, most recently with House passage of the Health Information Technology Promotion Act (H.R. 4157) in July. That bill is expected to be conferenced with the Senate version, which passed in November 2005.
At the same time, interest in improving the quality and effectiveness of health care has accelerated, with policies rapidly emerging from the Administration, Congress and the private sector. The President's August 20 Executive Order also called for federal actions designed to increase the transparency of quality and cost information for beneficiaries of federal government programmes.
The confluence of efforts surrounding not only information technology and health information exchange, but also requirements for and the alignment of incentives with quality improvement, create a near-term opportunity for transformation in the United States health care system. As efforts to both measure against and align incentives with goals around quality improvement and effectiveness continue to grow, health information exchange initiatives are beginning to explore expanding their services to offer an approach for supporting quality improvement that builds multi-stakeholder trust and creates a policy and technical infrastructure for information sharing with mutual agreement among providers, purchasers and payers.
Among the report's other key findings are the following:
- The level of policy activity and leadership at the state level has increased significantly in the last year.
- Policy development, planning, and HIE implementation activities are taking place at various levels of the system, but survey results indicate trends in the types of activities that are taking place at the regional, state and local levels.
- Health information exchange initiatives are continuing to mature.
- Interest in improving quality and safety, inefficiencies experienced by providers, and rising health care costs are the primary drivers for health information exchange efforts.
- Over 20 percent of respondents are exchanging clinical data.
- Services designed to support care delivery processes continue to be the primary focus of health information exchange efforts.
- Health information exchange efforts are continuing to offer services focused on quality improvement, positioning them for "value-based health care" support.
- Engagement of the multiple stakeholders in health care is expanding considerably with largest increases in hospital, health plan, employer and primary care physician involvement.
- Health information exchange efforts are significantly increasing efforts to connect with physicians.
- Increasingly, health information exchange efforts are tapping into users of their services to provide funding for ongoing operations.