advice for HIE challenges


Challenges Ahead: What’s Next for State HIEs?

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advice for HIE challenges

Though the technology can be complex, the non-technical aspects of a health information exchange are often the most daunting for states and regions adopting them, according to Jack Buxbaum, who helps organizations put HIEs in place and maintain them. He laid out the hurdles ahead for HealthBiz Decoded, and some of the ways states might overcome them.  

This expands on our previous coverage of the HIE sustainability problem, the challenges states will face and some preliminary thoughts on tackling them.


Healthcare is complex. Making a relevant Health Information Exchange is even more complex. Administrators, and people who run the business of healthcare, have valid questions, including:

  • Why am I doing this?
  • What is it doing for me?
  • What’s my return on investment even if my investment is minimal?
  • What’s the return on the indirect expense of my time and effort to do this?
  • Am I including patent care?
  • Am I reducing cost somehow?’

Those questions aren’t easy to answer, but they’re essential to assure adoption of the Health Information Exchange, particularly after the incentives that the government has offered begin to fade away.

3 Barriers

First, (obviously) an organization must agree to run the exchange.  Adoption is next, which is convincing doctors to use the system. If physicians don’t use this thing, it’s not going anywhere. They really are at the center of this.

I personally have this issue. My physicians are in the Stone Age, electronically. There’s a little bit of discord: Patients largely want the exchanges up and running, they want to be involved in their own health, but providers are more reluctant to commit to a new system. It’s an opportunity and a challenge.

The third barrier is economic sustainability. Like any business, you need a business plan, and you need to execute on it.

This is where HIE’s have a real obstacle to overcome. When funding from the federal government begins to wane, the providers must figure out how to sustain their HIEs. Options include:

  • Charge subscription fees or transaction fees.
  • Find sponsors to subsidize providers’ use of the system.
  • Sell data or data analytics to drug firms for research purposes.

Many people tend to wait until it’s an emergency before they react. As a result, they don’t have a lot of time to deal with their choices, which is something I recommend against. A concern that we all have in the industry is whether the statewide information exchanges have sustainability plans. And if they do, are they executing them?

Often there is too much focus on technology and not enough on sustainability.

Next Steps

In the industry, we’ve all been thinking about this for a long time. There are some interesting approaches that have been discussed in the sustainability world; some of them are a little trite, some of them are pretty ingenious.

Part of what makes it difficult to move forward is that there are no blueprints to follow. While it’s clear what the requirements are to protect patient health information, there is little clarity on how to go about protecting it.

The ultimate solution will be standards for sharing data – not regulations or laws. We must come to an agreement about standards for interoperability,  and for sharing information between health information systems. We will need representatives from vendors, providers, and other thought leaders – everyone who has skin in the game.

This may take years to do, but all those folks need to put together a national policy that lays out how we will handle privacy and security in health IT. Having an organization like that would bring everybody to the table, and set up a compromise that can benefit as many organizations as possible.

Jack Buxbaum is vice president of HIE Services at Xerox, where he helps states adopt and use information exchanges.