Survey: HIEs to boost interoperability for payers, providers

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Physician practices and hospitals are fighting an uphill battle when it comes to developing necessary infrastructure to support sending and exchanging secure data, according to a recent survey of current and potential provider and payer health information exchange (HIE) users.

Black Book Research, which specializes in healthcare market research and public opinion polls, announced its findings in an  April 7 release that identified a frustration among HIE users over a lack of standardization and readiness of providers and payers.

“Every stakeholder in the healthcare delivery process cannot establish the infrastructure needed to support interoperability, as evidenced by 83 percent of physician practices responding and 40 percent of hospitals, that currently admit they are still in the planning and catch up stages of sending and sharing secure, relevant data,” said Doug Brown, managing partner of Black Book.

Between Q3 2015 and Q1 2016, Black Book polled 2,012 provider HIE users, 2,300 payer HIE users and 4,100 prospective HIE users of all types regarding interoperability in strategic planning initiatives. Of those struggling with interoperability, 57 percent blamed their HIT/EHR vendors, while 20 percent placed responsibility on government agencies. Only 17 percent pointed toward their organization’s lack of funds or executive interest level.

In response to the trend toward values- and outcome-based healthcare, 90 percent of polled hospitals see private HIEs as more profitable and more sustainable. Sixty-three percent of hospitals reported actively replacing their current HIE system, whether private public, homegrown or EHR-dependent. Some 94 percent of responding payers intend to abandon public HIEs to work directly in regions or states to create or improve private HIEs.

“The value-based payment reform concept enabled by a robust HIE requires all stakeholders … to reach the goals of dynamic population health,” Brown said. “Focused, private HIEs also mitigate the absence of a reliable Master Patient Index and the continued lack of trust in the accuracy of current records exchange.”

According to Black Book, payers have largely avoided the development of private HIEs until late 2014 because data sharing was viewed as primarily benefiting providers. This suspicion appears to be waning, as 88 percent of hospitals and 95 percent of payers in Q1 2016 see the development and maintenance of secure data exchanges as building more collaborative, trusting relationships.

The survey showed a large majority of participants—85 percent of hospital leaders, 88 percent of physicians and 92 percent of payers—believe the Office of the National Coordinator for Health Information Technology has insufficiently enforced interoperability on EHRs and HIT vendors who have refused to complete bidirectional interoperability.

According to payers and hospitals, the arrival of an operational national HIE is approaching more quickly than previously expected. In 2015, 91 percent of payers and 74 percent of providers expected a national HIE to be possible by 2020. These numbers are optimistic compared to 2013, when 82 percent of payers and 60 percent of hospitals thought a national HIE was at least a decade away.

With the global health care analytics market projected to top $18.4 billion by 2020, the need for complex data systems will boost the interoperability needs of providers and payers.

“[Bidirectional interoperability] will ultimately force comprehensive interoperability into reality, not government-scripted vendor pledges,” Brown said. “Value-based care, payer participation in private HIEs, patient locator systems and analytics will be the real forces that push interoperability ahead.”

Patients agree on the need for medical data exchanges, according to Black Book. A Q3 2015 survey of recently discharged patients of 70 U.S. hospitals showed 94 percent wanted to have their medical and insurance information held and freely shared electronically among personal providers and payers.

The responding HIE provider users noted a number of significant forces leading to system replacement:

  • Potential for data breaches/privacy and security issues (97 percent)
  • Cost of custom interfaces/constrained budgets (93 percent)
  • Lack of connectivity with EHR-centric HIEs (90 percent)
  • Complexity of current HIE technologies (75 percent)
  • Questionable sustainability of HIE vendors or agencies (72 percent)