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Health information exchange: State analysis finds no one-size-fits all solution


The Office of the National Coordinator (ONC) is reviewing the effects of its health information exchange technology programs, focusing on efforts in six states. The study revealed that programs can’t be generalized across all states, and that tangible and realistic goals must be set to promote momentum for program success.

The Health Information Exchange (HIE) Cooperative Agreement Program was created in 2009 by the Office of the National Coordinator for Health Information Technology (ONC) and offers states and territories $564 million in funding and guidance on secure electronic information exchange.

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Now the ONC wants to review the effects of the program and has commissioned NORC at the University of Chicago to conduct a multi-year study of the program. A series of case studies were collected between 2012 and 2014 to provide in-depth insight into the implementation of the program in six states-Iowa, Mississippi, New Hampshire, Utah, Vermont and Wyoming.

The case studies revealed that most of the participants used both directed and query-based models to share information electronically. The most common services included care summaries, lab results, public health reporting, transmission of admission/discharge/transfer messages. Methods of choice for infrastructure depended heavily on Stage 1 and 2 meaningful use requirements, with some choosing federated models and/or centralized infrastructure for population management and analytics. Some states utilized support from Affordable Care Act (ACA) programs and payment reform, which created opportunities to reinforce their programmatic efforts, according to the report.

One of the primary findings from the report was that there is no one-size-fits-all solution when it comes to HIE. With so many differences in each state’s health system infrastructure, population size, and prior HIE experience, “accounting for local context is critical when designing technical, behavioral, or policy solutions to advance interoperable HIE.”

“Put another way, what works for Iowa may not work for New Hampshire,” the report states.

Some of the challenges to implementation noted in the report included realistic goal setting. “Tangible, intermediate goals” were most successful in keeping stakeholder energizes throughout the process, which must be defined and refined with course corrections as needed.

The report also found that across all states, stakeholder buy-in was essential to HIE success.

“The more parties supported, promoted, and participated in HIE, the easier the implementation path. Ideally, stakeholder buy-in also included collaboration between entities like state Medicaid, the Regional Extension Centers (RECs) tasked with technical assistance, and the State HIE Program leadership team,” according to the report.

Technology problems were reported among all six case studies, according to the report, including EHR and HIE developer limitations and lack of interoperability between systems.

MORE TECH COVERAGE: Interoperability remains a challenge for EHRs

In regard to the HIE requirement to develop sustainability plans beyond the funding period, the states involved in the case study have explored value-added services like care coordination and potential subscription fees for various users.

The report also outlined avenues of additional support. First was the important role states play in leadership and coordination in terms of policy development and needs assessment. Second, study participants outlined the need for strong, ongoing support related to standards and interoperability, and a provider- or federal-led effort to obtain buy-in from HIE developers to encourage interoperability.

To read the full report, visit

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