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.

Of the 2006 survey respondents that responded to the 2007 survey, eHI noted that 30 advanced at least one stage of development (excluding those who advanced to stage seven-a new stage reported on in 2007). Five initiatives moved from start-up (stages one or two) to implementation (stages three or four). Four initiatives moved from implementation to operational stages five, six or seven). In addition, all operational initiatives reporting in 2006 continued to be in operation in 2007. Finally, 15 additional initiatives participated for the first time in 2007.

In 2005, eHI developed a six-stage framework for assessing and tracking the development of health information exchange initiatives at the state and local levels. As part of the 2007 survey, eHI added a seventh stage of development to address the continuing maturity of these initiatives. Most initiatives focused on health information exchange will move through predictable stages of development, but at a varying pace. The seven stages of development are:

Stage 1	Recognition of the need for health information exchange among multiple stakeholders in your state, region or community. (Public declaration by a coalition or political leader)
Stage 2	Getting organized; defining shared vision, goals, and objectives; identifying funding sources, setting up legal and governance structures. (Multiple, inclusive meetings to address needs and frameworks)
Stage 3	Transferring vision, goals and objectives to tactics and business plan; defining your needs and requirements; securing funding. (Funded organizational efforts under sponsorship)
Stage 4	Well under way with implementation -technical, financial and legal. (Pilot project or implementation with multiyear budget identified and tagged for a specific need)
Stage 5	Fully operational health information organization; transmitting data that is being used by healthcare stakeholders.
Stage 6	Fully operational health information organization; transmitting data that is being used by healthcare stakeholders and have a sustainable business model.
Stage 7	Demonstration of expansion of organization to encompass a broader coalition of stakeholders than present in the initial operational model.

As noted in 2007, 32 organizations reported that they were "fully operational" with 12 organizations reporting they were in stage five; ten organizations reporting they were in stage six, and ten organizations reporting they were in stage seven. This compares to the 26 organizations which reported that they were fully operational in 2006. A full summary of the number of organizations in each stage of development is provided below.

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

In December 2007, Health Affairs published an article entitled "The State of Regional Health Information Organizations: Current Activities and Financing." Adler-Milstein et. Al. identified 102 organizations that were possibly pursuing data exchange, as compared to the 120 initiatives that responded to the eHI survey in 2007 and self-reported that they were at least at a stage one level of development.

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. A summary of significant drivers based on 2007 survey results is provided below.

Significant Drivers	2007	2006
Improving quality of healthcare	94%	91%
Improving patient safety	80%	82%
Inefficiencies experienced by providers	61%	70%
Rising healthcare costs	59%	56%
Availability of grant funding	32%	33%
Increased attention on HIT	31%	31%
Public health surveillance needs	26%	23%