Example White Paper:

HIEs and Successful Steps for Sustainability

Healthcare organizations are continually searching for solutions that can help the industry reduce its rapidly escalating costs. Health information exchanges (HIEs) have demonstrated their ability to improve the clinical and financial performance of healthcare organizations and, if properly designed, can have a clear and commanding return on investment. However, a large number of HIE initiatives rely solely on grant funding and therefore face considerable sustainability issues.

While grants can play an important part in the start-up or initial stages of an HIE, this funding is usually given all at once or only available during a specific period of time. Grants allow organizations to pursue implementation without establishing a self-sustaining revenue model up front. As a result, such HIEs must be prepared with a solution for when the grant money runs dry. A successful HIE model may use grant funding for start-up funds but does not count on those funds to cover operational costs beyond that stage.

There is continued growth in the number of operational HIEs for which sustainability is an attainable goal. According to a report by eHealth Initiative (eHI) titled “The State of Health Information Exchange in 2010: Connecting the Nation to Achieve Meaningful Use,” the number of HIE initiatives and those which are operational is steadily increasing. eHealth Initiative counts 234 active HIEs in the country as of July 27, 2010, and those operational initiatives are currently transmitting data that is being used by stakeholders.


Although HIEs play a crucial role in transforming the healthcare industry by enabling the systematic sharing of health-related information between disparate clinical systems and various organizations, or stakeholders, there is no magic bullet for long-term HIE sustainability. A successful HIE implements its mission phase by phase instead of rushing to build the organization all at once. For HIEs, also often referred to as regional health information organizations (RHIOs), to achieve future sustainability, there are certain steps that have to be taken, steps that do not result in instant gratification.


First, if an HIE is to be sustainable, a framework that is centered on what its stakeholders value is necessary. This requires community participation and effort by the stakeholders as they address issues that could affect the HIE. For most organizations, a successful HIE allows relevant healthcare data to be available when and where it is needed. It must not only contribute to improved patient care and safety but also assist in reducing the time and costs of delivering healthcare for it stakeholders. An HIE that benefits patients by placing increased burdens on providers is ultimately unsustainable.

Next, 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. Organizations sharing in the implementation and maintenance costs of solutions that facilitate the exchange of clinical information are able to obtain cost reduction. Although the “first movers” initially shoulder the financial burden, the cost-to-benefit ratio improves substantially as utilization of the exchange increases.

By demonstrating sufficient value, both existing and potential, in the early stages of an HIE, those funding it are able to see its inherent value and benefits. Adding a consistent review process to measure its success both financially and clinically allows those invested in an HIE to realize the need for continued involvement, providing another step in sustainability.

Third, an HIE that is to remain sustainable for years to come must become a hub for healthcare related information. It should be the central point for healthcare information for patients, providers and payers. In addition, it should offer value-added services, reduce administrative costs and facilitate reduced operational costs. Offering value-added services alongside the clinical exchange can be used to fund the HIE, eliminating a dependence on grants.

Promoting sustainable HIEs plays an important role in the improvement of quality, safety and cost-effectiveness of healthcare delivered throughout our country. They ensure that patients, providers, payers and anyone else involved have access to the right information at the right time. State-based and regional HIEs already in operation are providing important user benefits such as more timely communication and secure patient data exchange, regional collaboration and the elimination of inefficient and duplicate processes. Patients may stand to gain the most from HIEs by being allowed simple yet secure access to data from all of their healthcare providers with which to help make health decisions.


HIEs can support a variety of functions, including the exchange of clinical and administrative data, but they also offer other significant benefits for stakeholders both large and small. Some of the most noticeable benefits of a sustainable HIE apply to providers. Provider connectivity to other providers can save time associated with handling chart requests and referrals. Providers may enjoy improved quality of patient care and reimbursement rates while achieving greater patient loyalty.

An HIE may also increase incentives for providers to organize as teams centered on patient care while decreasing the medical rate of inflation. These providers can, through an HIE, enjoy streamlined coordination and communication, resulting in reduced administrative and billing issues while facilitating interaction between physician offices, hospitals, laboratories, pharmacies, patients and others.

Organizations such as eHealth Initiative and the American Health Information Management Association (AHIMA) are working to develop best practices and successful business models that demonstrate HIE sustainability. For example, AHIMA is taking an active role in standards setting efforts for HIE and has convened a Practice Council of Experts appointed by the Board of Directors to provide guidance to the Association concerning HIE.

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. HIE developers must know what participants expect to receive from the exchange and keep that goal in the forefront of the process. Especially for those organizations not reliant upon grant funding, sustainability is an attainable goal for HIEs as more and more organizations are providing services to patients and providing access to patient data through them. Once the road to sustainability is solidified, the goal of HIEs can move from survival to growth.