Communications, Connected Care and HIEs, Part 2

... continued from our previous post.

Some HIEs offer free portals into large health systems for independent providers

"Free" sounds good, right? Beware, this is not good news. Since large health systems always look for ways to expand and exert more influence, there is a common first step in creating a health information exchange. Such systems typically benefit by communicating with independent health care providers within their geographical area. Therefore, we see many examples of the large system offering free or low-cost portals to independent health care providers within the local area. Health systems are willing to provide a portal free or at low cost because they tie outside providers into the system and usually increase referral relationships. Connecting independent providers through such portals also increases political clout at the state level for the large systems, helping them take the position that the state system should be structured with independent providers connecting to the state, and eventually the national system, through the local large health system.  

There are pitfalls in this model for independent providers though. The “free” portal allows providers to view patient health information for only the patients who are already part of the health system. The portal does not provide communications capabilities with other health care providers (or their patients) outside the health system. This need isn’t even discussed in many situations as the large health systems are not yet ready to provide outside services. We are seeing a trend, however: the systems that have reached this point are initiating substantial connection fees, applicable to outside patients and providers. These new fees appear to be making this the most costly exchange model.

State level HIEs that serve as repositories of selected patient health information 

The next level of involvement we see from large health systems driving the structure of the state HIE is their support of a state system that connects large health systems through a state-level repository of patient health information. Typically, we see this developing at the state level, where a repository is formed and the large health systems in the state agree what kind of data is going to be stored and exchanged at that level. In most cases, these repositories are proprietary and different in every state. Some states have multiple repositories as large health system compete and do not necessarily want to cooperate with one another, for a variety of reasons.  

States that are attempting this type of exchange vary tremendously in their ability to connect. Some states, such as Maryland, already connect every hospital system and are already exchanging some data between all connected hospitals. Other states that are attempting to build repositories are still deciding what information to exchange. They are still establishing mechanisms for the sharing of information, so are not actually exchanging much or any information between members.  

Again, there are pitfalls with this type repository system being the core of a state HIE.  One of the long term issues is that repositories have to be maintained and tend to be expensive, entailing significant ongoing costs. With health care dollars shrinking, and the eventual loss of federal dollars, the long-term sustainability of exchanges structured around a repository needs to be proven. The other problem is that, even though many large health systems are offering portals and proposing that independent providers connect to the state level health system through the portal, most have been unable to demonstrate how health information from the independent providers can be routed through the system and shared with other health care providers outside the local system. 


And this brings us to our next topic: HIEs that support ONC Direct. Continued in Part 3.


Alistair Jackson, M.Ed.