The National eHealth Collaborative (NeHC), a Washington, D.C.-based public-private partnership established through a grant from the Office of the National Coordinator for Health IT (ONC), was created to enable secure and interoperable nationwide health information exchange to advance health and improve healthcare. NeHC recently released the results of its 2012 NeHC Stakeholder Survey in which respondents answered questions on health information exchange (HIE) and the challenges associated with its widespread acceptance. According to the survey, the top challenge at 61 percent was HIE funding and sustainability.
As previously stated, in order for HIEs to achieve future sustainability, certain steps have to be taken. First, it’s important to note that HIEs which rely heavily or solely on major grant funding face considerable sustainability issues. Second, if an HIE is to be sustainable, a framework that is centered on what its stakeholders value is necessary. Third, being able to measure the return on investment, or ROI, by stakeholders and the community in general is a necessary step in creating a sustainable HIE. Next, an HIE that is to remain sustainable for years to come must become a hub for healthcare related information. Even as HIEs have been shown to improve healthcare and lower costs, implementing a business model which highlights the need for funding from stakeholders who obtain value and benefits using technology to share health information among key healthcare providers is critical.
HIEs involve a high cost of operation, an issue HIEs should consider as they evaluate various revenue streams. In 2010, the ONC established the State Health Information (State HIE) Exchange Cooperative Agreement Program, a federal-state collaboration which funds states’ efforts to rapidly build capacity for exchanging health information across the healthcare system both within and across states. In total, 56 states, eligible territories and qualified State Designated Entities (SDE) received awards, the total funding for which was approximately $546 million. In early 2011, the ONC made an additional 16 million dollars available to states through its Challenge Grants program, which provides funding to states to encourage breakthrough innovations for health information exchange that can be leveraged widely to support nationwide health information exchange and interoperability. According to a recent survey, however, state officials are worried about how to keep paying for these programs once the federal money runs out by 2015.
To combat this prevalent issue, HIEs at the state level should first develop a business plan to examine the ongoing challenges of sustaining their infrastructure for interoperability without government funds. Thus, HIEs are challenged with finding other sources of revenue. A significant part of this revenue should come from value-added services, which assist providers in simplifying the administrative side of healthcare while generating a significant amount of revenue with which to sustain the HIE.
Value-added services should be those the community wants at a fee applicable to their specific market, and they should contribute to the sustainability of the HIE while matching its clinical priorities. Those HIEs that have enjoyed long-term success have typically implemented value-added services incrementally, starting with those that encourage participation and result in measurable revenue right off the bat.
Some state-run HIEs are providing value-add services specifically for providers. These services increase the sustainability proposition of the HIE by solving business problems for the provider members that purchase them. It is essential that HIEs, especially at the state level, understand what it means to be sustainable, the costs involved in supporting not only the organization but also the core and value-add services and the revenue streams that will be the most viable options for sustainability now and in the future.
Though not all value-added services revenues are directly measurable, they should all provide some level of value to the HIE. These services have to offer solutions to meet the needs of various stakeholders in order to improve quality of care and provide more favorable patient outcomes. In addition, the quality of the services an HIE offers needs to be even with or above those of similar service providers within the community.
A service of high value to the HIE and to stakeholders is the eligibility verification solution. A properly designed eligibility verification solution allows an HIE to quickly and effectively connect healthcare providers and health plans in real-time for the exchange of eligibility and benefits data. For payers, such a solution provides the ability to communicate patient-specific pre-authorization or eligibility to respond to various patient and provider queries. The ability of providers to access this information from one central place, the HIE, instead of multiple payer sites saves the providers time and money.
Another significant benefit of an eligibility verification solution is its ability to lower administration costs for an HIE. By streamlining transactions, the solution reduces rework, provides immediate and current patient data and results in a higher level of accuracy. For patient medication safety, eligibility verification coupled with the reconciliation of prescribed medication and generation of electronic prescriptions can improve patient medication compliance and reduce prescription errors. Advances in eligibility verification put eligibility and benefit information instantly at the fingertips of those who require it in an HIE.
Consent education and the e-consent process is yet another example of a value-added service needed by stakeholders to promote the viability of the HIE. The ability for HIEs to become a hub for healthcare related information is necessary for HIE sustainability and growth. For the HIE to become a healthcare information hub, patients, in many cases, must provide written consent of participation, but many are hesitant. Consumer education is needed to increase overall participation of patients and establish trust and support in an HIE. For that to happen, an HIE must have a way to obtain the support of patients and a way to capture electronic signatures. Without consent from patients to share their data, the viability and therefore sustainability of an HIE is limited significantly.
Though HIEs can face a myriad of challenges, their success can play a crucial role in transforming the healthcare industry by enabling the systematic sharing of health-related information between disparate clinical systems and stakeholders. They have been shown to improve healthcare and lower costs, enhance provider-patient communication and coordination of care, reduce the risk of medical errors and improve availability of clinical data. By addressing the challenges addressed in this blog, HIEs can continue to become an integral part of healthcare in the United States.