2019 Survey On HIE Technology Priorities - EHealth Initiative
2019 SURVEY ON HIETECHNOLOGY PRIORITIESTHE STATUS OF HEALTH INFORMATION EXCHANGE IN 2019eHealth Initiative Foundationwww.ehidc.org
About eHealth InitiativeeHealth Initiative and Foundation (eHI) convenes executives from every stakeholder group inhealthcare to discuss, identify and share best practices to transform the delivery of healthcareusing technology and innovation. eHI, and its coalition of members, focus on education,research, and advocacy to promote the use of sharing data to improve health care. Our visionis to harmonize new technology and care models in a way that improves population health,consumer experiences and lowers costs. eHI serves as a clearinghouse, and has become thego-to resource for the industry through its eHealth Resource Center. For more information, visitehidc.org.About Orion HealthOrion Health is a leading population health management company and one of the world’sforemost providers of healthcare integration solutions to healthcare organizations. Worldwide,Orion Health solutions are used in more than 20 countries by more than 300,000 clinicians. As aglobal health technology company, we provide an open platform which enables access tohealthcare by more than 100 million patients globally. In the US, the company providesinteroperability, population health management and precision medicine solutions for HealthInformation Exchanges (HIEs), Accountable Care Organizations (ACOs) and Payers. Thecompany is committed to continual innovation, investing substantially in research anddevelopment to cement its position at the forefront of precision medicine. More information canbe found at http://www.orionhealth.com. Connect with us on Twitter, Facebook and LinkedIn.2019 HIE Technology Priorities1
TABLE OF CONTENTSINTRODUCTION AND OVERVIEW . 3Background on Health Information Exchanges . 3SURVEY RESPONDENTS . 4METHODOLOGY . 4PAYERS PARTICIPATING IN EXCHANGES. 5HIE BUSINESS DRIVERS AND PRIORITIES . 6What are the Key Business Drivers? . 6What are the Top Priorities? . 6Is Sustainability No Longer an Issue? . 7INTEGRATING CLINICAL AND CLAIMS DATA . 8Why is it Important to Integrate Clinical and Claims Data? . 8Who has the Capability to Integrate Clinical and Claims Data? . 8Challenges in Managing Clinical and Claims Data . 9Are HIEs Prioritizing the Integration of Clinical and Claims Data? . 9SERVICES OFFERED . 10Current Capabilities . 10Which Services will be Offered in the Next Two Years? . 10Deep Dive into Service Adoption . 11Care coordination tools . 11Remote patient monitoring (RPM). 12All payer claims database . 12What are the Barriers to Adopting New Technologies? . 12DATA EXCHANGES . 13Which Data Types are Difficult to Exchange? . 13Deep Dive into Data Difficulties . 13Exchanging social determinants of health data is difficult for a majority of respondents . 13Medications filled data is somewhat more difficult for respondents with more members . 14Quality reporting data is easier for HIEs with fewer members . 14Progress in exchanging radiology images . 14Behavioral health data is more challenging for respondents with less members . 14POLICY PERSPECTIVE . 15Respondents Expect TEFCA to Make a Significant Impact on Interoperability . 15MOVING FORWARD . 162019 SURVEY PARTICIPANTS . 17ACKNOWLEDGEMENTS . 182019 HIE Technology Priorities2
Introduction and OverviewFor almost two decades, eHealth Initiative and Foundation (eHI) has monitored the state ofhealth information exchanges. Healthcare is experiencing rapid evolution with the emergence ofnew technologies and payment models. In response, both the public and private sectors areseeking ways to improve the quality and safety of care, resulting in a growing momentum toimprove interoperability. Organizations like health information exchanges (HIEs) and healthinformation networks (HINs) act as a source of valuable information and services, making thecontinued evaluation of their challenges, opportunities, and priorities important.Background on Health Information ExchangesAs the name implies, HIEs provide technology and services to help their stakeholders exchangeelectronic health information. HIEs do not provide healthcare services. Instead, they impact thequality and cost of care, and ultimately outcomes, by sharing patient health data acrossorganizations within a region, community, or hospital system.Numerous trends that will drive the adoption of new technologies, the ability to exchange variousdata types, and the direction of HIE priorities are already evident in 2019. The healthcare industryis in the process of adopting performance-based funding models in place of more traditionalreimbursement-based models. Industry is also facing an influx of value-based care initiatives;growing support for application programming interface (API) based interoperability standards,such as HL7 ’s Fast Healthcare Interoperability Resources (FHIR ); complex laws for sharing nontraditional types of data; and the push for nationwide exchange of electronic health informationacross disparate HINs. As new payment models emerge, healthcare stakeholders are increasinglyseeking out new types of data that will give a wider perspective of a patient’s health and socialexperiences.An HIE’s ability to integrate data enables and supports value-based care. Stakeholders canmonitor their quality and cost of care, leading to improvements in care quality and carecoordination, and eventually, cost savings. However, not all HIEs have the ability to integrate themany types of data necessary to enable and support value-based care and cost-loweringactivities. HIE capabilities may be limited for a variety of reasons, including technical functions,costs, competing priorities, and issues around ownership and control of the data by stakeholderorganizations participating in the HIE.Based on results from eHI’s 2019 Survey on HIE Technology Priorities, this report examines HIEperspectives on: Adoption of new technologyIntegrating clinical and claims dataTypes of data being exchangedBusiness drivers and prioritiesChallenges associated with the aforementioned2019 HIE Technology Priorities3
SURVEY RESPONDENTSFifty-three U.S. based organizations in 35 states completed the survey (Figure 1). A broad swathof organizations representing all corners of the nation were represented in the survey.Respondents had the option to select more than one type of HIE: 60% are a regional orcommunity HIE; 38% are a state-designated HIE; 23% are a private or proprietary HIE; and 4% arehybrid HIEs.Location of Survey RespondentsStates with at least one respondentFigure 1. HIEs were asked to select the state or U.S. territory in which their HIE is headquartered.METHODOLOGYThe 2019 Survey on HIE Technology Priorities was launched on February 19, 2019 and closed April12, 2019. Announcement of the survey was communicated through email and phone calls to alist of contacts identified as being in a leadership position at an HIE in the United States or a U.S.territory.The survey consisted of 20 multiple-choice questions. Participants were required to answer aquestion inquiring whether their organization facilitates the exchange of health information asan HIE (Yes or No). Those answering “no” to this question were disqualified and sent to the endof the survey. The remainder of the survey questions did not require an answer. Each responsewas reviewed carefully and significantly incomplete responses, duplicates, or responses fromorganizations not considered an HIE were excluded.After review, a total of 53 respondents were included in the results. A list of participating HIEscan be found at the end of this report. While responses were reviewed by eHealth Initiative stafffor reasonableness, this survey should be considered a non-scientific snapshot of industryperspectives and the state of the field.2019 HIE Technology Priorities4
PAYERS PARTICIPATING IN EXCHANGESWhen health information exchanges came intoexistence nearly two decades ago, very few payersparticipated in data exchange. Today, more payers areactively participating and exchanging data with HIEs.As a result, HIEs have access to significant amounts ofclaims data, information that is critical in forming amore complete picture of a patient.What does the term “members”mean in this report?100,000members1 millionmembers2.5 millionHIEs that work with a number of payers help exchangemembersdata for the millions of members each payerrepresents. The survey asked respondents to indicateIn this example, the HIE has access tohow many payers participate in their exchange, asclaims data for more than 3 millionmembers from 3 different payers.well as how many members those payers represent(see figures 2 and 3). For the purposes of stratifyingthe survey data, respondents were placed into groups based on the number of members forwhich the HIE manages payer claims, referred to as members throughout the survey.About half of the survey respondents (49%) have 3 or fewer payers participating in theirexchange. Of the organizations that have payers participating in their exchange, only 24% or 13organizations have access to the claims data for more than 3 million members. There are somedifferences between HIEs that manage large amounts of claims data and those that do not haveaccess to this data. These variances are explored in a later report section entitled IntegratingClinical and Claims Data.Payers Participating in an HIE# PayersParticipating in HIE% of respondents# of respondents015%81—334%184 — 1038%2011 or more13%7Figure 2. HIEs were asked, “How many payers participate in your exchange?”Number of Members Represented by Payers in HIE# of Members% of respondents# of respondents 1 Million34%181 — 3 Million23%12More than 3 Million but less than 5 Million9%55 — 10 Million15%8 10 Million0%0Not sure19%10Figure 3. HIEs were asked, “How many members are represented by payers in your HIE?”2019 HIE Technology Priorities5
HIE BUSINESS DRIVERS AND PRIORITIESWhat are the Key Business Drivers?Over the years, different market and policy drivers have helped propel health informationexchange. In 2019, respondents’ top business drivers were managing risk and delivery on valuebased contracts (58%), easier integration through APIs (47%), and providing clear value to endusers (47%) (Figure 4).Top Business Drivers% ofrespondentsBusiness Drivers# ofrespondentsDesire of stakeholders to manage risk and deliver on value-based58%care contracts31Easier integration through APIs, FHIR, etc.47%25Provide clear value to end users such as care transitionmanagement and medication reconciliation47%25Incentives from government agencies including CMS, state, andlocal authorities34%18Increased demand for population health analytics tools32%17Figure 4. HIEs were asked to select up to three of their biggest business drivers in the adoption of technologyHealthcare stakeholders who are planning on, or already are,taking on more risk are seeking partners and solutions that willhelp them deliver on value-based care contracts. HIEs areincredibly valuable in the world of value-based care due totheir ability to aggregate data and present it in a meaningfulway. Value-based care trends are influencing technologiesused by HIEs, with 92% of respondents somewhat orcompletely agreeing that the trends influence their decisions about technology adoption.Interoperability is critical for success in value-based care, and open APIs are seen by many as akey driver behind the shift to improve interoperability. Open APIs make health data available todiverse applications and users. As demonstrated by the survey, respondents acknowledge thevalue of these standards. Embarking on an API strategy can allow providers to retrieve and viewpatient data contained in the HIE and help HIEs strengthen their position in the market.What are the Top Priorities?Unsurprisingly, respondents are prioritizing interoperability (47%), value-based care (43%), andintegrating workflows (40%) in the next two years (Figure 5). HIEs are an encouraging solutionto the interoperability epidemic. They look beyond simply integrating electronic health records2019 HIE Technology Priorities6
(EHRs) and pharmacy systems to also include health researchers, nursing homes, behavioralhealth, and substance abuse. HIE efforts to enhance interoperability will bring the industry onestep closer to a more complete picture of the patient, putting HIEs in a unique position to impactthe quality, timeliness, safety, and cost of care.While all priorities listed in Figure 5 are important, it is important to note that respondents wereasked to select three top priorities. Though some options were selected less frequently, that doesnot mean it should be interpreted that they are not considered a priority by HIEs.Priorities in Next Two YearsPriorities% ofrespondents# ofrespondentsEnhance interoperability47%25Support value-based care43%23Integrate EHR and HIE workflows40%21Integrate non-traditional types of data like genomics and social34%18Enhance care coordination34%18Long term sustainability, financial viability32%17Participate in multi-state HIE26%14Improve patient care at participant organizations23%12Integrate clinical and claims data19%10Manage the opioid crisis17%9Identify and engage high-risk patients/members15%8Improve care in the Emergency Department8%4Use machine learning/artificial intelligence for precision medicine8%4Enhance privacy / security / safety6%3Enable telehealth4%2Figure 5. HIEs were asked, “Select your top priorities for the next two years. Choose up to three (3).”Is Sustainability No Longer an Issue?Achieving ongoing sustainability has challenged HIEs in thepast as evident in eHI’s 2005 Survey on HIE Initiatives andOrganizations. At that time, 84% of HIEs considereddeveloping a sustainable business model a very difficult ormoderately difficult challenge.iComparatively, only a third (32%) of respondents in the 2019 survey listed long-termsustainability and financial viability as a top priority in the next two years. Increased financialviability could be attributable to a number of factors. As HIEs have grown to scale, they haveestablished themselves in their communities and are demonstrating clear value. In addition, thenumber of HIEs in the U.S. has decreased in the last two decades due to changing economicconditions, consolidation, and market forces.2019 HIE Technology Priorities7
INTEGRATING CLINICAL AND CLAIMS DATAWhy is it Important to Integrate Clinical and Claims Data?An HIE’s ability to integrate clinical and claims data enablesand supports value-based care, allowing stakeholders tomonitor their quality and cost of care, leading toimprovements in care quality and care coordination, andeventually, cost savings. However, not all HIEs are able tointegrate data and are challenged by limited resources,tools, capable staff, quality data, and access to claims data.Additionally, the integration of clinical and claims data maynot be a priority for some HIEs at this time.Access to both claims and clinical information helps payers monitorand provide coordination of services, complete a variety of qualityassurance reporting requirements, augment reporting efforts forvalue-based initiatives, and support administrative transactions.While claims information already held by the payer may providesome data for these activities, clinical data can enhance theeffectiveness, completeness, accuracy, and usefulness of theactivities.The majority of respondents (67%) report that they have seen a significant or very significantincrease in demand from payers for more access to clinical data. At this time, 84% ofrespondents believe the services they are providing to payers are valuable.Who has the Capability to Integrate Clinical and Claims Data?Access to both claims and clinical information helps payers monitor and provide coordination ofservices, augment reporting efforts for value-based initiatives, support administrativetransactions, and complete quality assurance reporting requirements. As discussed earlier, 15%of respondents are not working with any payers. Of those organizations that have payersparticipating in their exchange, 24% or 13 organizations have access to the claims data for morethan 3 million members. These organizations have the greatest opportunity and capability tointegrate the data.In comparing groups with different numbers of members represented by payers in the HIE’sexchange, 85% of respondents with greater than 3 million to 10 million members are able tointegrate clinical and claims data while only 50% of respondents with 3 million or less membersare able to integrate the two types of data.2019 HIE Technology Priorities8
Challenges in Managing Clinical and Claims DataHIEs are faced with numerous challenges related to resources, sources of data, and technology.Survey results suggest that for respondents with at least one payer participating in theirexchange, the most significant challenges in managing claims and clinical data are data qualityissues (58%), cost of technology (56%), and availability of qualified staff (49%) (Figure 6).Respondents also cite the availability of claims data as asignificant or very significant challenge (44%) in themanagement of clinical and claims data (Figure 6). It isdifficult to bring claims data into an HIE for many reasons.Clinical and revenue cycle management systems were notdeveloped to integrate with each other, creating technicalbarriers. Additionally, state laws, provider membership, andcontractual agreements create differences in patientparticipation and consent models.Challenges in Managing Clinical and Claims DataChallenges% ofrespondents# ofrespondentsData quality issues58%26Cost of technology56%25Availability of qualified staff49%22Claims data not available44%19Privacy/security policies that limit transactions40%18Figure 6. HIEs identifying challenges in managing clinical and claims data as Significant or Very Significant.HIEs that responded as having zero payers in their exchange or not sure were excluded from thesecalculations.Are HIEs Prioritizing the Integration of Clinical and Claims Data?Only 19% of respondents chose integrating clinical andclaims data as a top priority for the next two years(Figure 5). It could be that plans want clinical data touse in their own decision-making tools, rather thanhaving the HIE integrate clinical and claims data andperform analysis on behalf of the payer. Respondentschoosing this as a priority were almost evenlydistributed between the 3 million or less members group and the more than 3 million to 10million group.Survey respondents are seeing a significant increase in the number ofpayers asking for access to clinical data.2019 HIE Technology Priorities9
SERVICES OFFEREDHIEs offer many services and tools that benefit providers, payers, patients, and hospitals. Thissurvey asked respondents which services they have already adopted and which services they arelikely or not likely to adopt in the next two years. Respondents shared their biggest barriers toadopting new technologies and indicated how likely it is their technology budget will increase.Current CapabilitiesAs Figure 7 demonstrates, HIEs are already offering services such as provider alerts (77%) andHIE to HIE exchange (72%), while very few HIEs are offering services such as remote patientmonitoring (6%).Services Currently Being Offered – HIEs OverallType of Service% of Respondents# of RespondentsProvider alerts77%40HIE to HIE exchange72%38Care coordination tools40%21E-referrals/E-consults21%11All payer claims database15%8Medication reconciliation11%6Remote patient monitoring6%3Figure 7. Percentage of HIEs indicating they have already adopted the following challengesWhich Services will be Offered in the Next Two Years?The survey indicates a likely increase in HIE technology budgets. Technologies such as carecoordination tools are likely or very likely (40%) to be adopted by respondents in the next twoyears while others like remote patient monitoring are not likely or not very likely (40%) (Figure8).Likelihood of Services to be Offered in Next Two Years – HIEs OverallNot likely orNot very likely%#Type of TechnologySomewhat likely%#Likely orVery likely%#Care coordination 16All payer claims database21%2215%819%10Medication reconciliation8%830%1634%18Remote patient monitoring40%2613%717%9Figure 8. “What is the likelihood of your HIE adopting the following technologies in the next two years?”2019 HIE Technology Priorities10
Deep Dive into Service AdoptionThe following section is a deep dive into the likelihood of service adoption in the next two yearsfor respondents with 3 million or less members, compared to respondents with more than 3million to 10 million members. Figures 9 and 10 reference this data.Likelihood of Services to be Offered in Next Two Years — 3 Million Members or LessType of ServiceNot likely orNot very likelySomewhat likelyAlreadyadopted thistechnologyLikely orVery likely%#%#%#%#HIE to HIE exchange7%20%033%1060%18Provider 33%1023%7Remote patient monitoring47%1420%617%53%1Care coordination tools3%17%254%1633%10Medication reconciliation17%527%837%1110%3All payer claims database50%1517%520%67%2Figure 9. HIEs with 3 million or less members represented by payers. “What is the likelihood of your HIE adoptingthe following technologies in the next two years?”Likelihood of Services to be Offered in Next Two Years — More than 3 to 10 Million MembersType of ServiceNot likely orNot very likelySomewhatlikelyAlreadyadopted thistechnologyLikely orVery likelyHIE to HIE exchange0%00%00%092%12Provider 1%415%2Remote patient monitoring54%70%08%115%2Care coordination tools0%08%123%362%8Medication reconciliation8%131%430%415%2All payer claims database23%315%216%238%5Figure 10. HIEs with more than 3 million to 10 million members represented by payers. “What is the likelihood ofyour HIE adopting the following technologies in the next two years?”Care coordination toolsCare coordination tools can enhance communication between providers, improve outcomes andpatient safety, and reduce unnecessary testing. Forty percent of respondents have alreadyadopted care coordination tools. A third (33%) of respondents with 3 million or less membershave adopted the tools and 54% are likely or very likely to adopt these tools in the next two years.2019 HIE Technology Priorities11
For respondents with more than 3 million to 10 million members, 62% have adopted carecoordination tools and 23% are likely or very likely to adopt the tools the next two years.Remote patient monitoring (RPM)RPM is a healthcare delivery method that usestechnology to monitor patient health outside of atraditional clinical setting. HIEs may support RPM bysharing generated data or generating a notificationthat a remote visit occurred. Very few respondentsreported adopting RPM (6%) and are not likely ornot very likely to do so in the next two years (40%).Almost half (47%) of respondents with 3 million orless members are not likely or not very likely to adoptRPM and only 3% have already adopted the technology. Over half (54%) of respondents withmore than 3 million to 10 million members are not likely or not very likely to adopt RPM, whileonly 15% have already adopted the technology.All payer claims databaseOnly 7% of respondents with 3 million members or less have already adopted an all payerclaims database, 50% are not likely or not very likely to adopt within the next two years, andonly 20% are planning to adopt one in the next two years. Thirty-eight percent of respondentswith more than 3 million to 10 million members have adopted an all payer claims database and16% are likely or very likely to to do so in the next two years. Twenty-three percent are not likelyor not very likely to adopt in the next two years.What are the Barriers to Adopting New Technologies?Although the majority of respondents (74%) indicated their technology budgets are likely toincrease in the next two years, several challenges to the adoption of new technology persist.Respondents report that the cost of technology (87%), competing priorities (74%), and enhancedutilization and optimization of the solution (72%) are significant challenges.Top Challenges in Adopting New TechnologyChallenges% ofRespondents# ofRespondentsPrice/cost87%45Competing priorities74%38Enhanced utilization and optimization of the solution72%38Adaptability of the technology59%31Technical challenges41%22Figure 11. Challenges in adopting new technology rated significant or very significant2019 HIE Technology Priorities12
Data ExchangesWhich Data Types are Difficult to Exchange?HIEs typically exchange clinical, claims and cost, pharmaceutical research and development,public health, and quality reporting data. As the healthcare industry aims to gain a more accuratepicture of a patient through access to a wider range of data types, some data are proving moredifficult to exchange than others.Most Challenging Data TypesTypes of Data% ofRespondents# ofRespondentsSocial determinants of health52%27Behavioral health50%26Advance directives, living wills, power of attorney documents46%24Genetic35%18Medications filled35%18Device data27%14Patient-reported data27%14Unique identifier(s) for implantable device(s)27%14Care plans25%13Claims data23%12Quality reporting21%11Figure 12. “Which of these types of data is your organization having difficulty exchanging?”Deep Dive into Data DifficultiesThe following section provides a deep dive into difficulties in exchanging data types forrespondents.Exchanging social determinants of health data is difficult for a majority of respondentsSocial determinants of health (SDOH) dataoffer promise for addressing socio-economicissues that impact a patient’s health. A lackof consensus on standards for capturing andrepresenting SDOH data creates barriers toits collection and use, as does n sharing. Overall, 52% of respondents experience difficulty in exchanging SDOHdata. Fifty-seven percent (n 30) of respondents with 3 million members or less and 42% (n 12)of respondents with more than 3 million to 10 million members are having difficulty exchangingSDOH data.2019 HIE Technology Priorities13
Medications filled data is somewhat more difficult for respondents with more membersThe ability to see medications filled data gives stakeholdersthe opportunity to recognize and track patients who fail t
2019 HIE Technology Priorities 1 About eHealth Initiative eHealth Initiative and Foundation (eHI) convenes executives from every stakeholder group in healthcare to discuss, identify and share best practices to transform the delivery of healthcare using technology and innovation. eHI, and its coalition of members, focus on education,
HealthInfoLaw.org State HIE Consent Policies: Opt-In or Opt-Out Last Updated September 2016 The State HIE Consent Policies: Opt-In or Opt-Out table provides a 50 state plus the District of Columbia comparative overview of patient consent policies, enacted either through legislation or agency guidance, that may govern health information exchanges (HIE) operating in each state.
of Informatics. The interviews were structured to elicit information in three broad subject areas: Barriers to HIE; Drivers of HIE - those things that motivate participation; and Assistance needed to move forward with HIE. The interviews revealed a wide variety of comments in each subject area, which were then grouped into categories.
2004: RI’s HIE, now known as CurrentCare, efforts initiated 2007/2008: State designated RIQI as the Regional Health Information Organization 2008: HIE Act of 208 passed and required opt in model – for sending data to HIE – to identify which provider
CAMDEN HEALTH INFORMATION EXCHANGE Page 6 of 48 Purpose: The purpose of this Policy is to define procedures ensuring that Patients understand how their information will be used through the Camden HIE and must be given the right to "Opt-Out" of having their information in the Camden HIE made available for access. Policies:
HIE Help Center: Caregiving Resources 3 HIE Caregiving: Care Considerations, Advice and Resources Care Considerations .
Financing and Policy (DHCFP) developed this survey for assessing uses of Health Information Technology (HIT) and Health Information Exchange (HIE) within Nevada's provider community. Understanding your organization's use of HIT and HIE is important for various reasons, including the following: To establish a baseline for assessing Nevada's HIT .
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