Rhapsody Health Solutions Team

Health Information Exchange: What’s the Motivation?

This post was originally published in 2012. See more recent content on Health Information Exchanges.

HIE Series. Part 1 of 6.

Now that the majority of innovative healthcare organizations have invested the capital, the time and the effort to install electronic medical records, many are looking to fully leverage the technology by connecting to a health information exchange, or HIE.

According to eHealth Initiative’s “2011 Report on Health Information Exchange: FAQs,” there were 255 HIEs in 2011, an increase of 9% from 2010. A majority (70%) of existing HIEs are private, yet just 24 total claim to be sustainable.

See: Forward-Looking Organizations are Connecting to HIEs to Improve Care

There are several reasons why HIEs are a logical “next step” for health providers who have implemented EMR systems, including qualifying for Meaningful Use or serving as a precursor – or “test case” – for connecting to a future Accountable Care Organization. Whatever the motivation, both examples can mean significant revenue for the organization:

  • The earlier a health care organization qualifies for Meaningful Use Stage 1 requirements, the more financial benefit the provider or health organization will receive as part of the Medicare Electronic Health Records (EHR) incentive program. For Medicare-eligible hospital systems, qualifying for Meaningful Use in 2011 means receiving millions of government dollars earlier than if they qualify at a later date. (Visit this CMS Meaningful Use page and scroll down to the “Medicare-Eligible Hospitals” section for detailed reimbursement information.)
  • Care providers who are members of an ACO, as defined in the Affordable Care Act, can potentially earn significant Medicare rewards for the realized cost savings from bundled payments and meeting pre-defined quality of care benchmarks. While EMRs are not required of all ACO providers, they are required to perform an analysis of the ACO’s overall patient care metrics against the 32 benchmarks set by the U.S. Department of Health and Human Services.

HIEs also have the potential to provide cost savings to connected organizations in the forms of increased productivity, avoidance of duplicate medical procedures, and the resulting shared savings as a result of payment by episode of care.

While revenue or a positive return on investment is always the key motivator for organizations to make costly business moves such as installing EMRs or paying to connect to HIEs, the good news for patients – which includes everyone – is that both Meaningful Use requirements and ACOs share a common end result – improving the quality of patient care.

The argument whether or not HIEs or ACOs are the proper way to improve the patient experience are best left for political blogs. The reality for health IT professionals is that HIEs are forming in every state, yet there is uncertainty about the different forms of HIEs and what challenges health organizations likely will face when trying to exchange data within a HIE.

I hope to help address these topics in future articles in this six-part HIE blog series. Themes of future posts will include:

Part 1: Health Information Exchange: What’s the Motivation?
Part 2: Architecture Types
Part 3: Despite Momentum, HIE Sustainability a Concern
Part 4: The Building Blocks of HIEs: A Glossary of Terms
Part 5: HIE Communication Methods
Part 6: HIE Physician and Patient Portals

Additional Resources

Round Table on HIE Connectivity: Real Experiences with Health Information Exchanges

EHR/HIE Interoperability Workgroup Releases Technical Specifications

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