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New Survey From Harvard Researchers Casts Serious Doubt On Future Of Regional Health Data Exchange

 Despite The Hype, Many Regional Health Data Networks Fail; Those That Survive Tend To Have Narrow Participation And Limited Information Exchange

Bethesda, MD -- The widely held vision of achieving electronic clinical data exchange across the United States is far from a reality, with few organizations facilitating such exchange and many failing in the process, says a new Web Exclusive study by Harvard researchers published today by Health Affairs. http://content.healthaffairs.org/cgi/content/abstract/hlthaff.27.1.w60

The study, based on a 2007 survey of 145 regional health information organizations (RHIOs), is a comprehensive assessment of the state of electronic health data exchange in the U.S. Electronic health data exchange between hospitals, doctors’ offices, labs, and other clinical settings has been hailed as the key to improving the quality, efficiency, and coordination of care.

But the new survey, funded by Harvard’s Program for Health Systems Improvement, identifies serious barriers to achieving this goal with the current approach.

RHIOs Limited In Spread And Size

At the time the survey was conducted, nearly one-quarter of the 145 RHIOs were defunct. Only twenty initiatives were deemed to be of at least modest size and exchanging some clinical data. Five of those RHIOs exchanged data for a specific population, such as Medicaid enrollees, the uninsured, or patients with a chronic illness like diabetes. Only fifteen RHIOs exchanged clinical data across a range of patient populations.

“These findings suggest that nationwide electronic clinical data exchange will be much harder than what many people have envisioned,” said lead study author Julia Adler-Milstein, a doctoral candidate in health policy at Harvard University. “The expectation has been that we will have RHIOs throughout the country that bring together all the providers in their region and engage in comprehensive data exchange. In reality, we’re seeing few established RHIOs, and those that are established only have a small number of participating groups exchanging a narrow set of data.”

Adler-Milstein’s coauthors are Andrew McAfee, an associate professor at the Harvard Business School; David Bates, chief of general medicine at Brigham and Women’s Hospital, and Ashish Jha, an assistant professor at the Harvard School of Public Health.

Most successful RHIOs started by focusing their efforts on exchanging test results from laboratories and imaging centers, Adler-Milstein noted, adding that that’s where she believes the clearest return on investment lies. Exchange of other data -- such as clinical notes -- is much more difficult to achieve, partly because cost savings from such initiatives are less tangible, she said.

Sustained Funding Sources Needed

Establishing a successful RHIO is not only hard work; it’s expensive, with significant up-front costs, Adler-Milstein remarked. The current approach to establishing RHIOs tends to rely on small start-up grants with the hope that participants will be willing to pay the RHIO once data exchange is initiated. The survey findings suggest that some RHIOs are struggling with the transition to self-sufficiency, as eight of the twenty moderate-size RHIOs reported that they continued to depend heavily on grants. In contrast, nine never received grant funding. Thirteen RHIOs said that they collected recurring subscription or transaction-based fees from participants to stay in operation.

“If we want RHIOs to attain the vision of comprehensive health information exchange, we need to increase our investments in them,” Adler-Milstein said. “Otherwise, many of these RHIOs will be unable to sustain themselves under the current market-oriented approach.”

Other facilitators of success include the following:

-- Data standards than enable different computer systems to “talk” to each other
-- Health data privacy and security safeguards
-- Community buy-in, including overcoming health care providers’ competitive concerns
-- Financial incentives to provide high-quality, cost-effective care

“While many RHIOs are struggling, some have figured out a way to sustain themselves and that is a reason for hope,” said coauthor Ashish Jha. Both authors suggest that meaningful financial incentives for high-quality, efficient care--the so-called “pay-for-performance” (P4P) programs--will help advance clinical data exchange. “Either we have to create the right market conditions or have much greater public investment, but the vision of a national health information network is unlikely to come to fruition without one or the other,” said Jha.

 

ABOUT HEALTH AFFAIRS:

Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org.

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©2007 Project HOPE–The People-to-People Health Foundation, Inc.