Industry evolution makes the death of the #HIE model inevitable

HIE imageBack in their heyday, health information exchanges (also known as Regional Health Information Organizations) looked like they might have legs. The clinical rationale for HIEs made sense  — after all, who would argue with the idea that data sharing improved care? — and grants to support them were springing up out of the woodwork. True, some HIEs capsized even in the early days, usually because they ran out of grant money or provider funding — but the idea still seemed sound to many healthcare industry leaders.

Over time, however, many HIEs have collapsed, still unable to make their business model work. While few health execs argued that HIE data sharing was a good thing, capable of eliminating duplicative tests and supporting coordinated care, health leaders simply didn’t want to pay for them. They also weren’t thrilled about sharing data with their competitors, particular when they competed in dense urban areas with hospitals on every block.

But as bad as those attitudes have been for the future of HIEs, current trends are far worse, all but guaranteeing that the HIE model will go out with a whimper.  Interoperable EHRs should take their place.

New data sharing models

While the market for HIE organizations is bleak, the market is guaranteed to snap up the right tools for data flow between risk-sharing ACO partners. And it would be no surprise if the HIT vendors capturing an early share  of the market were those who are already known for data connectivity.

According to a Black Book Research study which surveyed operators of public and private exchanges, top HIE vendors include Cerner  (for its HIE to EHR capabilities), Orion Health (for government payer and commercial insurer-centric HIEs) and Aetna Medicity (for core private enterprise HIE solutions.)

As providers pick up value-based contracts from payers, and desperately need decent data sharing to coordinate care, I can only  imagine that  they’ll turn to familiar names  to help them make that transition.  Data connectivity based on regions will die out, but vendor solutions that support ACOs and population health analytics will soar.

The HIE was a good idea, but it’s never been given a real chance to fly, and now its moment has passed.  The HIE is dead; Long live the Clinical Data Network.

Our recommendations:

  • While most of the energy around HIE building has focused on enterprise-level technology, it’s time to make things workable for the patient.  Conduct campaigns to engage consumers in data sharing, standardize the patient identification process so patients don’t develop workarounds that drop data out of the system.Begin planning  an architecture which makes not only EMR data, but also data from mobile devices, wearables and remote computers available to your partners. After all, it’s inevitable that you’ll need to get your arms around this information for internal purposes anyway.
  • If you want your clinicians to use new data streams from post-HIE networks, you’ll have to explain what’s going on. Prepare to educate them proactively, and often, how new dashboards and analytic capabilities can help them meet both ACO requirements and their patient care goals.


  1. Reply

    I agree with you that the concept of a broker between data holders is heavyweight and unnecessary. But interoperable EHRs leave the big problem of trust unresolved. Some authority still has to ensure that the data recipient is really who she says she is and has the right to the data. DirectTrust is one solution that works with the Direct protocol, but newer data exchange mechanisms (notably FHIR) need to build up technologies and organizations for trust.

    • admin


      Thanks for your thoughts Andy. How effective is Direct Trust, and what are its limitations? Does FHIR show more promise?

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