by: Dr. Satyendra Kaith, Adjunct Professor, Kaplan University, School of Business and Information Technology
While most experts on health information exchange (HIE) agree with the transformational potential of HIEs to support a system that delivers coordinated, affordable and quality healthcare services, recent research and events highlight the lack of robust empirical evidence of HIEs improving quality of care and providing value to patients and to participating entities.
A report on HIE and ROI (Anjum, Diana, & Luce, 2012) suggests that there are no standard metrics used by HIEs to evaluate their impact. With more than a decade of experience in using HIE data for quality reporting and ROI calculations in a fully operational HIE in central Texas, this research team claims that both a sustained effort with adequate resources and a commitment to collaborate across organizational boundaries are required to develop meaningful metrics. The study concludes by identifying the need for the HIE community to take the lead in developing metrics to evaluate the benefits of information exchange:
“The transformational changes that HIEs promise come much later and require trust, evidence-based approaches, perseverance, and collaboration among all healthcare stakeholders. It would be disappointing if the already high rate of HIE failures increased in the next few years as federal funds are exhausted.”
Anjum, Diana and Luce warn that without incorporating quality of care and ROI metrics into their business model, many HIEs may not survive. It is no wonder, then, that Bill Rudman, Executive Director at the American Health Information Management Association (AHIMA) Foundation, told InformationWeek Healthcare that the report is a wake-up call for healthcare stakeholders (Lewis, 2012).
The need for quality of care and return on investment (ROI) are further validated by Mary Mosquera, a Washington, DC, area freelance journalist covering healthcare payment and delivery reform, business and technology. Mosquera foresees the business value of HIE as an evolving driving force, even though most HIE professionals typically pay more attention to the technology involved. She refers to Farzad Mostashari, MD, the ex-national health IT coordinator, and a January 29 2015 joint hearing of the federal advisory Health IT Policy and Standards committees focused on business value of health data exchange. Mostashari specifically noted Camden Coalition’s Director, Sandy Selzer, who described how the Camden, N.J., HIE has managed a sustainable return on investment: their costs are low, and they have found a way to add value through simple admissions/discharge/transfer (ADT) transactions messages, with their existing business relationships within that community (Mosquera, 2013).
Interestingly, in spite of the hard facts provided above, a report published by Becker’s Hospital Review cites a study published in AHIMA’s Perspectives in Health Information Management revealing that only 50 percent of health information exchanges use or plan to use metrics to measure their impact. The study found the most likely reason for the lack of uniform metrics is an absence of incentives to develop and use them (Roney, 2012).
“HIEs are emergent organizations and it stands to reason that they would experience growing pains,” Kyle Murphy, Ph.D. (2012), writing for EHR Intelligence, said of the study. She further added, “But given the millions in government grants that many HIEs are apparently squandering, few are likely to sympathize with the heads of these organizations if they refuse to get their act together and, more importantly, their books in order.”
Although federal funds have provided more incentive for the HIE movement to promote meaningful HIE, it seems that the burden of demonstrating quality of care and ROI, including the incorporation of meaningful use of metrics and evidence of success, is going to be squarely on HIEs.
Have you heard of any meaningful metrics that demonstrate an HIE’s value within the healthcare community? What ideas do you have for HIEs that are identifying these important metrics? We want to hear from you!
Anjum, K., Diana, M. L., & Luce, S. D. (2012). Health Information Exchange: Metrics to Address Quality of Care and Return on Investment. Perspectives in Health Information Management, 9(Summer: 1e).
Lewis, N. (2012, September 18). Health Information Exchanges Struggle To Prove ROI. Retrieved February 8, 2015, from Information Week: http://www.informationweek.com/interoperability/health-information-exchanges-struggle-to-prove-roi/d/d-id/1106370
Mosquera, M. (2013, January 31). Mostashari spotlights ROI in HIE. Retrieved February 10, 2015, from Healthcare IT News: http://www.healthcareitnews.com/news/mostashari-spotlights-roi-hie
Murphy, K. (2012, September 6). Study reveals prevailing lack of HIE sustainability. Retrieved February 11, 2015, from https://ehrintelligence.com/2012/09/06/study-reveals-prevailing-lack-of-hie-sustainability/
Roney, K. (2012). Study: HIEs Need Metrics to Address Quality of Care, ROI. Becker’s Hospital Review.