eHealth Initiative Releases Results of 2007 Survey on Health Information Exchange

Trends show advancement in a small number of markets, but action is needed to
support U.S. health information exchange sustainability now more than ever

WASHINGTON - December 19, 2007 - Today, the multi-stakeholder non-profit eHealth Initiative (eHI) released the results of its 2007 Fourth Annual Survey of Health Information Exchange at the State, Regional and Community Levels, taking stock of 130 community-based efforts designed to improve health and healthcare through the mobilization of health information electronically.

Summary of Key Findings

STATE OF THE FIELD: WHAT'S HAPPENING?

• Health information exchange initiatives are continuing to mature.
  Overall, those health information exchange initiatives who have participated in the eHI annual survey have matured. While in 2006, there were 26 fully operational health information exchange initiatives, 32 reported that they were fully operational in 2007. Thirty 2006 survey respondents reported an advancement in their stage of development in 2007.

• Some health information exchange initiatives are no longer moving forward.
  eHI counted five initiatives that were included in the 2006 survey that were no longer moving forward in 2007. At the same time, the 2007 survey includes 15 new health information exchange initiatives which were not included in the 2006 survey

• The most important drivers include those related to improving quality, improving patient safety, and addressing inefficiencies experienced by providers.
  As in 2006, the most significant drivers for health information exchange were improving quality (94 percent) and improving patient safety (80 percent). In addition "inefficiencies experienced by providers" (61 percent) and rising health care costs (59 percent) were also cited as significant drivers.
  

WHAT IS THE PRIMARY FOCUS OF HEALTH INFORMATION EXCHANGE INITIATIVES?

• Increasingly, health information exchange efforts are exchanging clinical data.
  Overall, the percentage of health information exchange initiatives exchanging data is on the rise with 34 percent of 2007 respondents currently exchanging lab data and 32 percent exchanging data related to outpatient episodes, up from 26 percent and 21 percent respectively, in 2006. Exchange of emergency department episodes, inpatient episodes, outpatient laboratory results, and radiology results are also up from 2006, with 30 percent, 28 percent, 28 percent, and 26 percent, respectively, offering these services in 2007.

• Supporting direct care delivery continues to be the focus of health information exchange efforts, but providing population health related services continues to be an emphasis for some—particularly more advanced stage initiatives.
  In terms of supporting care delivery, twenty-nine percent of 2007 respondents provide “results delivery” services to the users of the health information exchange initiative—up four percent from 2006, while 25 percent offer clinical documentation services, and 21 percent offer enrollment or eligibility checking services. At the same time 16 percent of 2007 survey respondents are offering chronic care management services, while 11 percent are offering quality improvement reporting to clinicians.

• Health information exchange initiatives are increasingly adding support functions to augment data services.
  The percentage of health information exchange initiatives offering additional support services is slightly up, across the board, in 2007, with 33 percent supporting practicing clinicians with adoption of electronic health records; 32 percent offering a help desk function; 30 percent supporting practicing clinicians with work-flow analyses; and 19 percent supporting quality improvement or performance reporting for purchasers or payers.

WHO'S LEADING? HOW ARE THEY ORGANIZED?

• Health information exchange initiatives are continuing to formalize their operations through the creation of formal legal entities.
  Health information exchange initiatives are continuing to establish legal entities to support their operations, with more than half (55 percent) having established legal corporations, 14 percent continuing to be incubated within another organization, and eight percent remaining a “loose group of collaborators”.
  
  For those who have created a legal organization structure for their efforts, more than two-thirds (68 percent) have chosen a non-profit corporation model, while eight percent have chosen a limited liability company model, five percent have chosen a for-profit corporation model, and five percent have chosen a “virtual model”--which is not a legal entity, but an initiative formed under contractual arrangement.

• Clinicians, community health centers, employers, health plans, hospitals, patients, and quality improvement organizations are most likely to play a governance role in health information exchange efforts.
  For the most part, health information exchange initiatives have migrated to a model whereby multiple, diverse stakeholders are participating in the effort. Those organizations that are participating in the governance of health information exchange efforts include hospitals (67%), primary care physicians (49%), health plans (43%), community health clinics (40%), local public health departments (37%), patient or consumer groups (30%), specialty care physicians (32%), employers (24%) and quality improvement organizations (21%)

ISSUES AROUND FINANCING ARE THE MOST PRESSING CHALLENGES

• The most significant challenge for health information exchange initiatives is the development of a sustainable business model.
  The most significant challenge for health information exchange initiatives in 2007 was developing a sustainable business model, with more than half (56 percent) of respondents citing this as a very difficult challenge and more than one-third (35 percent) citing this as a moderately difficult challenge. Other areas identified by respondents as “very difficult challenges” included securing upfront funding (53 percent), defining the value that accrues to users (43 percent), and addressing privacy and confidentially issues (34 percent).

• While health information exchange initiatives continue to rely on federal and state agencies for up-front funding, the level of funding provided by hospitals is up considerably from 2006, moving ahead of government funding as the top funding source.
  In 2007, the top sources of upfront funding for health information exchange initiatives were hospitals (53 percent), federal government grants and contracts (44 percent), state government (43 percent), private payers (32 percent), and philanthropic sources (31 percent).

• Funding for ongoing operations is increasingly reliant upon non-governmental sources
  According to the 2007 survey results, hospitals were the top funding source for ongoing operations at 61 percent, followed by the federal government (38 percent), physician practices (37 percent), private payers (37 percent), state government (35 percent), and public payers (31 percent).

OPERATIONAL INITIATIVES OFFER GUIDANCE FOR SUCCESS

• Advanced stage initiatives—those fully operational—share some common characteristics that offer guidance for a path forward.
  eHI’s 2007 survey report highlights 32 health information exchange initiatives that have identified themselves as fully operational. A profile of those organizations is outlined below.
  • Three quarters of operational initiatives are no longer dependent on “non-operating revenue”, which are described as grants or advance payments.
  • Operational initiatives derive their revenues for ongoing operations from hospitals (58 percent), physician practices (46 percent), private health plans (46 percent), laboratories (33 percent), and the federal government as well as philanthropic organizations (both 29 percent).
  • Most operational initiatives utilize subscription fees or membership fees from data providers (92 percent) or data users (85 percent) to support ongoing operations. Seventy eight percent of operational initiatives charge transaction fees to data users while 67 percent charge transaction fees to data providers.
  • About half (52 percent) of operational initiatives received their start-up funding from the federal government, while nearly half (48 percent) received start-up funding from hospitals, 30 percent from private payers, 30 percent from the state, and 30 percent from philanthropic sources.
  • Three quarters (seventy five percent) of operational initiatives offer “results delivery” as one of their services, followed by clinical documentation at 63 percent.
  • A strong majority of operational initiatives are exchanging outpatient episodes (84 percent), outpatient laboratory results (76 percent), laboratory results (73 percent), inpatient episodes (64 percent), and radiology results (63 percent).

WHAT ABOUT THE STATES? WHAT ROLE DO THEY PLAY IN HEALTH INFORMATION EXCHANGE?

• State policymakers are continuing to demonstrate leadership in using health information technology and health information exchange to drive improvements in health and health care.
  As this report will show, a number of states are also moving forward in parallel with federal efforts on the development and adoption of policies for improving health and healthcare through health information technology (IT) and electronic health information exchange. Recently, we have seen a significant increase in state-level legislative action regarding health IT and quality improvement. While there was virtually no legislation at the state level related to health IT prior to 2005, in 2005 and 2006 thirty-eight states introduced 121 bills specifically focused on health IT, and of those, 36 bills were passed into law in 24 states. Since the beginning of 2007, 208 bills have been introduced across all 50 states that refer to the adoption or implementation of health IT, nineteen of which have been signed into law in sixteen states.
  
  State legislation is becoming increasingly sophisticated, calling for a focus on improving the quality of care through the use of health IT, rather than focusing on health IT alone. Several of these bills also authorize funding of state initiatives, or establish exploratory and investigative task forces to facilitate state progress.
  
  U.S. governors are also playing a critical role in moving forward. To date, 20 executive orders have been issued by governors in 15 states, which are designed to drive improvements in health and healthcare through the use of IT--nine executive orders in 2007 alone.