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”, 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).
Source of Funding for Ongoing Operations |
2007 |
2006 |
Hospitals |
58% |
54% |
Payers - private |
46% |
19% |
Physician practices |
46% |
33% |
Payers - public |
38% |
18% |
Laboratories |
33% |
42% |
Federal government grants and contracts |
29% |
17% |
Philanthropic organizations |
29% |
21% |
Public health |
25% |
20% |
State or local government contracts |
21% |
26% |
Other |
21% |
12% |
Purchasers and employers |
17% |
0% |
Pharmacies |
13% |
11% |
Pharmaceutical |
4% |
6% |
Consumers |
0% |
7% |
Quality improvement organizations |
|
12% |
Most operational initiatives utilize subscription fees or membership fees to 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.
Service |
2007 |
Subscription fees or membership dues to data providers |
12 |
Subscription fees or membership dues to data users |
11 |
Transaction fees charged to data users |
7 |
Transaction fees charged to data providers |
6 |
Other |
5 |
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.
Source of Start-up Funding |
2007 |
2006 |
Federal government grants and contracts |
52% |
44% |
Hospitals |
48% |
17% |
Payers - private |
30% |
24% |
Philanthropic sources |
30% |
32% |
State government grants and contracts |
30% |
21% |
Payers - public |
11% |
18% |
Physician practices |
11% |
19% |
Laboratories |
7% |
5% |
Local government grants and contracts |
7% |
|
Loans from financial institutions |
4% |
12% |
Manufacturer/vendor contributions |
4% |
6% |
Medical societies |
4% |
|
Pharmaceutical contributions |
4% |
6% |
Quality improvement organizations |
4% |
0% |
Three quarters (seventy five percent) of operational initiatives offer “results delivery” as one of their services, followed by clinical documentation at 63 percent. A full list of services delivered is provided below.
Services |
2007 |
2006 |
Results delivery (e.g. laboratory or diagnostic study results) |
75% |
67% |
Clinical documentation |
63% |
54% |
Consultation/referral |
54% |
56% |
Enrollment or eligibility checking |
54% |
56% |
Alerts to providers |
48% |
44% |
Electronic referral processing |
35% |
35% |
Reminders |
33% |
39% |
Disease or chronic care management |
32% |
32% |
Quality improvement reporting for clinicians |
29% |
22% |
Public health: electronic laboratory reporting |
28% |
39% |
Quality performance reporting for purchasers or payers |
26% |
17% |
Disease registries |
24% |
17% |
Public health: surveillance |
24% |
17% |
Public health: case management |
21% |
13% |
Patient access to information through the exchange |
12% |
9% |
Patient-provider clinical data exchange |
12% |
17% |
Patient-provider communication - other |
12% |
13% |
Patient-provider email |
8% |
4% |
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).
Data Types Exchanged |
2007 |
2006 |
|
|
|
Outpatient episodes |
84% |
70% |
Outpatient laboratory results |
76% |
65% |
Laboratory |
73% |
70% |
Inpatient episodes (diagnoses, procedures, discharge summaries) |
64% |
65% |
Radiology results |
63% |
61% |
Enrollment / eligibility |
62% |
75% |
Dictation / transcription |
58% |
61% |
Pathology |
58% |
48% |
ED episodes |
58% |
77% |
Outpatient prescriptions |
58% |
57% |
Cardiology |
57% |
52% |
Pulmonary |
54% |
57% |
Claims: pharmacy, medical, and/or hospital |
50% |
63% |
GI |
50% |
52% |
Retail pharmacy |
46% |
35% |
Radiology images |
29% |
30% |
Patient-reported data |
25% |
27% |
