Throughout August I have been exploring the question of which vendors have the largest and the fastest growing B2B integration networks. Certainly, a candidate for fastest growing networks (along with e-prescription networks and GDSN Data Pools) are the series of Health Information Exchanges (HIEs) popping up around the US. A recently released report from the eHealth initiative entitled the “State of the Health Information Exchange in 2010” indicates that there are over 230 active Health Information Exchanges (HIEs) operating in the US. Many of these HIEs have been recently founded using federal funds allocated through the HITECH program of the American Recovery and Reinvestment Act (ARRA).
Given the recent wave of federal funding, it should not surprise you that only 73 of the total 230 HIEs are categorized as being operational. The eHealth initiative categorizes operational HIEs as those which are actually transmitting Electronic Health Record data that is being used by health care “stakeholders.” What are the other 160 doing you might ask?
- Defining vision, goals and objectives
- Identifying funding sources
- Establishing governance structures
- Technical implementation and testing
So Many HIEs So Little Ties
One of the key issues with US HIE market is the high degree of fragmentation. There are 230 HIEs over the 50 states, DC and 5 territories. Only 17 HIEs are operating in multiple states. Most are statewide (21). However, there are even smaller geographic areas represented. For example, 11 HIEs cover a single county and 6 HIEs cover only a single city or part of a county. As a result of the abundance of local HIEs, many of the more populated states have multiple HIEs operating within their borders. Florida alone has 22, while New York (20), California (15) and North Carolina (13) are not far behind. HIEs have also been established in numerous US territories including Guam, Puerto Rico, American Samoa, Virgin Islands and the Mariana Islands.
Source: eHealth Initiative
Network of Networks
The current architecture of HIEs is a patchwork of regional, state and county level networks each operating independently. The HIEs do not interoperate today, which means that EHRs can only be shared within the confines of the geographic regions of their home network. Interoperability is not foremost on most HIE’s minds as simply getting two providers within a community to exchange data with one another is still a major milestone most have yet to achieve. Only 3 state-designated HIEs are exchanging data across state lines today. However, there is a vision and plan to connect the HIEs together into one larger National Health Information Network (NHIN). The NHIN would provide portability of EHRs across the entire nation ensuring that patients receive optimal care even when traveling to other states.
The eHealth Initiative study found that 8 state-designated HIEs were planning interstate data exchange in the next 12 months and that another 13 had similar ambitions over a 24-month period. Perhaps, a more important statistic is the number of HIEs adhering to NHIN standards and policies, a necessary pre-requisite for interoperability. 16 state-designated HIEs are reported to be following NHIN guidelines today with another 10 entities planning to do so within 12 months.
Source: eHealth Initiative
Growing, but Sustainable?
Interoperability between HIEs will help to realize the vision and benefits of E.H.R.s. However, the fragmentation of the HIE market naturally leads to concerns about the financial viability of these networks in both the long and short term. In fact, building a sustainable business model was the top concern cited by HIEs in the eHealth study. A current concern for many in the industry is the dependency of HIEs upon continued Federal or customer funding to support their operations. The ARRA funds have provided the “startup capital” for many of these organizations. In other cases, HIEs have been created by consortia of providers or payer organizations. The governance and ownership models behind these consortia HIEs are hauntingly reminiscent of the B2B e-marketplaces of the dot com era.
Source: eHealth Initiative
The good news is that there are over 100 HIEs that are not currently dependent upon Federal funds. And over 60% of surveyed HIEs stated that all of the organizations they exchange data with are independent entities (i.e. have no equity or other financial relationship). Nonetheless, operating 230 different HIEs around the US does not lead to a sustainable model in my opinion. Starting with smaller exchanges organized around local communities will catalyze growth, but likely lead to an eventual consolidation of networks.
Growing, but the Fastest?
The eHealth Initiative report includes excellent year-over-year statistics on adoption rates by transaction type, participation levels and geographic regions. In fact, I wish similar statistics were available on B2B e-Commerce in the financial services, retail or manufacturing sectors. However, the report does not provide any data on transaction volumes or revenues generated. Consequently, a direct comparison of the growth rates of HIEs as compared to other types of B2B integration networks is challenging. But there is no question that if we were to compare by the dollar values of new investment or the number of new vendors, HIEs would place #1.