Health Info Exchanges Gain Ground as Patient Data Sharing Tools

As the scramble to get physicians onboard with electronic health records, or EHRs, garners headlines across the country, another piece of the high-tech puzzle has been gaining ground -- the health information exchange.

A health information exchange moves health information "from point A to point B and back again," according to Jennifer Covich, chief operating officer of the eHealth Initiative, a nonprofit organization that works to improve the quality of America's health care system through the use of enhanced health information technology. The exchanges generally operate within a region or community and give health care organizations the ability to move clinical information electronically among health care providers within the exchange.

Exchanges help physicians interface with different data sources, Covich told AAFP News Now. To understand how such a system would work, she said, envision a wagon wheel. "It's a lot easier to connect to that middle part instead of directly contracting with 100 different organizations."

According to Covich, physicians don't necessarily need a full-fledged EHR system in their practices to start exchanging patient information with other health care stakeholders. "You don't have to go out and spend $100,000 to share data," she said. "You can start reaping the benefits by connecting to an exchange through an online interface.

"It's all about pulling all these different groups together in a community to try and improve care."

The eHealth Initiative maintains an online directory that lists exchanges by state and stage of development. The organization has identified nearly 200 active health information exchange initiatives around the country that are in various stages of development.

Covich said exchanges often spring from a community need. For example, a group of health care stakeholders in Louisiana started a health information exchange as part of a telemedicine project focused on reducing breast cancer rates in the region. They needed a method to exchange mammogram results and get data back to patients in rural areas, she said.

According to the eHealth Initiative's sixth annual survey of health information exchanges, "Migrating Toward Meaningful Use: The State of Health Information Exchange," (47-page PDF; About PDFs) the number of operational exchanges is increasing; between 2008 and 2009, the number of initiatives grew from 42 to 57.

The report also notes that operational exchanges have positively affected physician practices and helped them increase efficiency without disrupting patient care. Users reported better access to test results, fewer hassles in locating information, and a reduction in staff time spent handling lab results, radiology reports and clerical tasks.

Survey respondents reported that practice efficiencies resulted in shorter workdays and an improved quality of "practice life."

Covich said she hears comments such as, "Wow, this made my life so much easier!" from physicians all the time. "It's all about improving quality at the actual point of patient care … getting the right information to the doctor at the right time for the patient," she said.

Of the operational initiatives surveyed for the report, 40 reported cost savings in areas such as staff time spent handling lab and radiology results and clerical tasks. The exchange of information resulted in fewer redundant tests and helped ensure more efficient delivery of chronic care services at a lower cost. Additional savings came from decreased medication errors.

Although the report notes that health information exchanges reduce costs for a variety of stakeholders, hospitals and physician practices could see the greatest return on investment, in part because these organizations top the list of stakeholder organizations that share data through the exchanges.

Other groups exchanging health information include public health clinics, subspecialty physicians, independent labs and radiology centers, ambulatory surgery centers, pharmacies, health plans, state and local health departments, independent radiology centers, Medicaid, employers, and consumers.

The sheer number of patient records available through the exchanges -- collectively, more than 111 million among 48 of the 57 operational exchanges -- is a strong indication of the growing support for the technology.

According to Covich, time and money are key to developing and sustaining health information exchanges. "Generally, it takes these organizations about one to three years to get up and running," she said.

Most initiatives rely on federal and state funding, initially. According to the report, start-up costs can range from less than $200,000 to more than $5 million. Ongoing revenue sources include hospitals, physician practices, public and private payers, laboratories, and local government grants and contracts.

Although most operational initiatives said they didn't rely on federal funding for sustainability, the report's authors noted that "many still hope to benefit from the government's interest in the area."

Indeed, health information exchange-related provisions in the American Recovery and Reinvestment Act of 2009 will add about $300 million to the pot of money available to shape health information exchanges in the United States, said the report's authors.

Covich called the infusion of money and the government's keen interest a "double-edged sword," however.

"We've got the attention, we've got the money, we've got the support of the administration; all eyes are upon us right now, and we can't blow it," she said.

Covich said the challenge is documenting best practices and lessons learned from the exchanges that already are fully functioning. "We've got this critical mass of organizations out there that know how to do this," she noted, adding that the availability of stimulus money has provided a short and unique window of opportunity.