Clinical Services
Community and state-run HIEs may offer a number of clinical services.  Sometimes these services are included as core services as part of a subscription or transaction fee model.  In other cases, clinical services may also be value-add services.  HIEs should be flexible enough to adjust their core services to ever expanding market expectations, regarding core service options.  Some examples of clinical services include:

• Secure messaging – Facilitates the transfer of patient information between different stakeholders, such as providers, hospitals, labs, and radiology centers, thereby reducing cost and increasing quality of care.
• ePrescribing – Allows providers and hospitals to submit prescription requests electronically, thereby reducing errors and increasing efficiency.  In addition, some ePrescribing systems report on fill rates, enabling providers to better manage patient care.
• Electronic Health Record (EHR)-Lite – Some community and state-run HIEs are offering an EHR-Lite option for providers who do not have an EHR system.  The EHR-Lite is typically cloud based (hosted on the HIE’s servers rather than installed in a provider’s office), and is ONC certified which facilitates achieving meaningful use.  These products significantly reduce the providers cost for implementation and ongoing maintenance and upgrades.  It also allows the state-run HIEs to meet the ONC requirement that they support all providers in achieving meaningful use.
• Laboratory and radiology results delivery – The electronic delivery of lab and radiology results increases efficiency for providers and hospitals and the quality of care for patients.  It also decreases the cost associated with faxing or mailing results and potential medical errors. 
• Picture Archiving and Communication System (PACS) Reporting – Enables the management and distribution of medical images captured by multiple modalities (x-ray, CT, MRI, PET, and others).  PACS Reporting has the potential to decrease the costs associated with medical errors and the current costs of sending images between providers and hospitals.  In addition, it can reduce the costs associated with duplicative testing by providing physicians with access to prior images captured in another location.
• Interoperability Services - Physician practices can have their certified EHR connected to the exchange without point to point interfaces being built.  This breaks the practice silos as they are able to exchange data, while also indicating which of their specific data is to be made available for query, thereby providing a more complete picture of a patient's health to authorized physicians. EHRs may also connect using state of the art IHE profile technology, enabling query and retrieval capabilities for the EMR user interface.

Administrative Services
Administrative services are a revenue stream being considered by many community HIEs and a large number of state-run HIEs.  This revenue stream may be attractive for the state-run HIEs that have the ability to connect with their state Medicaid Management Information System (MMIS).  Administrative services being offered to providers and hospitals include the following:

• Claims processing – Allows providers and hospitals to submit claims electronically through a centralized mechanism.  This service eliminates multiple claims submissions through different payer systems as well as paper claims.
• Eligibility verification including universal eligibility – Allows providers and hospitals to verify eligibility electronically, typically on one system rather than multiple systems or via fax or telephone.
• Prior-authorization – Allows providers and hospitals to submit prior-authorization requests through a centralized mechanism.  This service eliminates paper and fax submissions for prior-authorization, decreases wait time for the authorization, and streamlines the request process.

The three administrative services above are not only beneficial to providers and hospitals, but are also beneficial to payers.  When claims processing, eligibility verification, and prior-authorization services are performed through an HIE, payers and providers may not incur the additional financial burden of supporting additional software and hardware systems to perform these functions.

Payer Value-Add Services
The use of an HIE has the potential to lower licensing, maintenance, and operational fees that payers would incur, if they supported these services themselves.  Some HIEs are offering the following value-add services for Healthcare Payers:

• NCQA/HEDIS Reporting – Allows payers to collect data through the HIE to support NCQA and HEDIS reporting requirements.  Utilizing HIEs provides better data in a more timely fashion.
• Wellness programs and care coordination support – Payers can use wellness programs and care coordination support from HIEs to lower costs associated with claims payment.  The HIE also allows payers to support increased care management by providing the care manager a complete picture of the patient.
• Patient education – HIEs can provide patient education, potentially through a portal.  Education materials can include videos, brochures, articles, and tutorials that will assist patients in managing their care.  When patients manage their care effectively, costs are reduced.  Payers can utilize an HIE to provide this patient education eliminating the operating costs of providing the information themselves.
• Treatment cost calculators – Facilitates better management of consumer's own healthcare by identifying patients' costs associated with a specific treatment before care.  Cost calculators allow payers to set consumer expectations and ultimately decrease unnecessary utilization.

Provider Value-Add Services
Community and state-run HIEs are providing value-add services specifically for providers.  These services increase the sustainability proposition of the HIE by solving business problems of the provider members that purchase them, a portion of which goes to extend ongoing support to the HIE.  For example, according to Mark Bell, CIO of the North Carolina Hospital Association, "North Carolina hospitals and providers are coming together to leverage the benefits of a shared HIE platform to maximize operational and clinical value. Highlighting shared services such as patient inquiry, messaging, labs, e-prescribing, CCD generation, clinical alerts and public health reporting helps build the case for cost-sharing among the participants of an exchange, minimizing the cost of sustainability. The shared HIE approach empowers robust models of care among diverse stakeholders, including the advanced medical home and Accountable Care Organization, which benefit patients and the healthcare delivery system as a whole."

The following value-add services will become increasingly important in enticing providers to join an HIE in the future.

• Meaningful Use – Providers need assistance in meeting Meaningful Use objectives and measures; especially as the health information exchange requirements increase. Providers look for an HIE that can meet the requirements now and in the future.
• Quality reporting – Assists providers in participating in the CMS Physician Quality Reporting System (formerly PQRI) and hospitals in participating in the Hospital Quality Initiative program.  This service can help providers record and report quality metrics to CMS, potentially increasing their incentive payment.
• Continuity of care applications – As the patient centered medical home model grows, providers will be looking for ways to provide continuity of care to patients.  HIEs that can offer applications that will allow providers to handle transitions of care will likely benefit.

Other Stakeholder Services

• Visiting nurses are alerted when a patient is admitted to a hospital, saving them a trip to the patient’s home.  Necessary clinical information is available so they can progress the care process.

• Eldercare agencies - health care providers are able to view medical and social supports that human service agencies provide senior patients, alongside their clinical information. This data is essential for discharge planners, care managers and other providers who benefit from a better understanding of their patient’s home setting and services.

• EMS – Access patients medications, allergies, conditions and more while being able to provide the HIE with information that they perform while in route to the hospital.