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The Politics of Health Care

HIE Options: The Battle Between Public and Private Continues

Published August 15, 2012 2:11 PM by Rebecca Hepp

As Meaningful Use criteria push towards required interoperability and changing reimbursement methods necessitate more coordinated care, HIEs are looking more and more appealing to hHealthcare providers. The HIE market practically exploded last year, growing more than 40%, according to a Chilmark Research report.

"As federal incentives drive the adoption of electronic health record (EHR) technology in the U.S., we will quickly move into the post-EHR era where the value of patient data is not what is locked in an EHR data silo, but the cumulative patient data that resides in the community HIE network," said John Moore, founder and managing partner of Chilmark Research.

And those looking to tie their systems together have plenty of options, too, when it comes to the type of HIE. The State Health Information Exchange Cooperative Agreement Program distributed $548 million to states, territories, and state-designated entity HIE startups in 2010, starting the slow creation of public HIEs. But many provider organizations, unwilling to wait for public HIEs to launch, have developed private HIEs — focusing on exchanging data among their own facilities and select outside partners.

While the KLAS report HIE Perception 2011: Public or Private? found that providers were split between selecting a public and private HIE, the tides have turned in favor of private exchanges, according to the Chilmark Research report. Organizations worried about data control or funding sustainability, or looking for a faster implementation time, are opting to create their own, private HIEs rather than wait to join larger, public HIEs. As federal funds dwindle, and state HIEs struggle to implement sustainable business models and develop fee structures through their state legislatures, private HIEs are becoming a more enticing option.

But with private HIE benefits come limitations. The KLAS report listed increased integration and interfacing needs as a possible deterrent, and a recent Journal of the American Medical Informatics Association article took a much closer look at the private vs. public HIE debate. According to the article, private HIEs, which only serve pockets of providers, may be draining resources necessary for public HIEs — which, by mandate, must provide broader services to entire communities and states — to succeed. Public HIEs are designed to connect providers on a grand scale, developing both intra- and inter-state exchanges; if private HIEs corner the market on profitable services, public HIEs have little chance of survival when providing lower ROI services such as connecting rural providers or developing the necessary standards and policies.

But don’t despair, because there may be a way to have it both ways, according to the article. Kentucky, as well as several other states, is working to create a public HIE that operates as an umbrella organization, linking all of the state’s HIEs, including private ones. During a National eHealth Collaborative roundtable, Claudia Williams, director of the State Health Information Exchange Program, recommended that states leverage the burgeoning private HIE development through an umbrella model similar to Kentucky’s, and focus on providing necessary services not met by the private sector.

This approach offers the best of both worlds: private HIEs can link specific provider networks, while the overarching public HIE brings competitors together by connecting all HIEs, as well as private practices not already part of a private HIE. The public HIE would also offer required exchange capabilities with state immunization registries, patient locator services, and new birth and cancer registries.

“In my mind that is a pretty good model. It makes sense to me that some public entity brings all of those [private] entities together, where there really isn’t a motivation otherwise,” said Steven Roth, vice president and CIO of Pinnacle Health System in Harrisburg, Pa, which developed its private HIE in 2009 after failed attempts to create an operable public HIE in 2007.

While public HIEs struggle to get up and running, private HIEs are popping up all over the country to address the immediate information exchange needs of technologically progressive providers. Although private HIEs have taken the lead, HIEs of both kinds are still in flux, and both have much to offer when it comes to sharing information.

1 comments

I never thought I would find such an everyday topic so enthrlailng!

Arnie Arnie, uobFtbcSLvigW - jhLJXdGWayF, GkEWxPbK October 23, 2012 10:16 PM
oODLaWwVb SD

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