The success of health information exchange (HIE) implementation will depend on local markets and its perceived value to that locality, according to a webinar on HIE hosted by Open Health IT Exchange.

The educational webinar, hosted by the Minneapolis-based OHITX, brought together industry experts to provide participants with resources and guidelines to support all stages of HIE.

“In terms of business, HIE does not conform to one business model,” said Rick Krohn, president of HealthSense, a healthcare management business based in Guyton, Ga. “Form follows function. The form of HIE has to conform to the local market.”

A key consideration for HIE implementation would be to start with standards that the intended community accepts, according to Lynne Dunbrack, program director of health market research firm IDC Health Insights, of Framingham, Mass. Then an organization can identify data limitations and establish a critical mass while resolving workflow issues, Dunbrack said.

“Workflow redesign is really important [in the HIE process] because there are many providers who don’t understand the significance of workflow redesign and expect that when they move [to EMRs], they will take their paper and pencil processes with them,” said Peggy Evans, director of the Washington & Idaho Regional Extension Center (WIREC).

Realizing that many providers cannot achieve meaningful use--particularly smaller providers--without assistance, the Regional Extension Center (REC) program, funded under the HITECH Act, was created to offer a combined $644 million distributed to 60 RECs across the U.S. to provide technical assistance to regional providers in hopes to achieve meaningful use, Evans said.

With an 80/20 percent targeted population split between Washington and Idaho, respectively, WIREC deploys a three-pronged approach to provide onsite technical assistance for providers, board education (teleconferences, regional meetings, etc.) and establish peer-to-peer IT communities to share IT lessons learned. WIREC’s goal is for 2,400 primary care providers to achieve stage one meaningful use and receive incentive funding from CMS.

“There is an understandable need that RECs are going to need to work with other projects that are related specifically to HIE,” said Evans. If an organization enrolls providers into a program without planning for workflow redesign, “you [will] have an unhappy EHR implementation,” she added.

“The number of services and functions offered by HIEs are increasing,” Dunbrack said. IDC Health Insight’s annual short list for the HIE market included a wide range of HIE vendors and services, she said. Of the vendors included in the short list, only four have more than 50 HIE customers (including enterprises, statewide initiatves, RHIOs, etc.), according to Dunbrack.

The short list included Axolotl, Browsersoft/OpenHRE, Carefx, dbMotion, eClincialWorks, InterSystems, MEDecision, Medicity, Medseek, Microsoft, Oracle, Orion Health, Patient Keeper and RelayHealth.

Whether using a centralized, federated or hybrid model of HIE, Krohn stated that to begin down a sustainable HIE path, an unmet need must be identified. “There is an industry perception that HIE is a software venture,” said Krohn. This isn’t true, he said: HIE is a “service organization that happens to have a technology component.”

A recognized value must be identified, and Krohn suggested amplifying small, incremental wins. Through education, a demand or value can be created and, as a result, revenue will hopefully follow, he said. Some common elements of successful HIE deployments include:

• A business strategy driven by local economies, organizational culture and competition.
• A governance strategy applied across a broad array of stakeholders.

Dunbrack emphasized that during the planning phase of HIE, organizations should articulate problems they are trying to solve before beginning a system search, given the range of applications. Echoing Krohn, she went on to say that stakeholders and clinical users should be engaged in HIE that demonstrates value.

“There are no failures, only findings,” Dunbrack said.

Looking toward the future, Dunbrack said she expects “HIE technology will become a commodity and the real value will come from what organizations do with that exchange of health information” as the market matures over the next 12 to 24 months.