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Gaining easy access to essential information is a perennial challenge in healthcare. However, despite being a technology that has been in use for nearly 20 years, Health Information Exchanges (HIEs) still have the potential to revolutionise how patient data is shared and used in diverse settings. In this insight, we share some of the views of health system buyers that Signify Research has interviewed over the last 12 months.
The Signify View
When looking for HIEs, buyers seek interoperable, standardised solutions that can seamlessly integrate diverse data from different healthcare settings and systems supported by high refresh rates to foster clinical point-of-care applications. They also need the HIE solution to be flexible, filter through the information it holds, and enable the provider to use off-the-shelf and in-house developed analytics tools to interrogate the data.
An HIE is a centralised repository, sometimes called a data lake, of pertinent clinical data that is aggregated from electronic health records (EHRs), medical histories, lab findings, imaging reports, insurance claims, social determinants of health (SDoH) and other data sources.
Integrating data from various sources through an HIE facilitates data-driven decision-making. It does this at an individual level by creating a Longitudinal Health Record (LHR), and at an aggregate level by providing a comprehensive view of population health.
Leveraging a patient’s complete health history, LHRs enhance care coordination and promote seamless healthcare planning, ultimately enhancing patient safety. Meanwhile, Population Health Management (PHM) strives to improve health outcomes on a larger scale by addressing health inequities, implementing targeted treatments, enhancing preventive care techniques, optimising resource allocation, and promoting general wellness within a population.
Role of HIEs in LHRs and PHM
In Signify Research’s upcoming report on the HIE market (HIE – World – 2024), the market is segmented into four HIE categories: national, state-wide, system-wide, and hospital-specific. Each class provides varying levels of data sharing and interoperability.
Types of HIEs
Great Expectations
Signify Research’s extensive interviews with IT system buyers offer valuable insights into purchasing criteria. This insight illustrates the data that potential buyers wish to incorporate into the HIE, examines current usage and limitations of existing HIE systems, and elucidates the expectations and preferences of buyers of HIEs, particularly system-wide HIEs in the US.
In recent years, the US healthcare system has been transitioning from a traditional fee-for-service model to value-based care (VBC). This has resulted in the adoption of collaborative healthcare delivery approaches in the form of Integrated Care Networks (ICNs) and Accountable Care Organizations (ACOs). ICNs have common ownership and emphasise integrating and coordinating healthcare services across providers and settings to ensure comprehensive patient care. ACOs don’t always have common ownership and focus on aligning financial and quality incentives among providers to improve patient results and control healthcare costs. Both models share the goal of enhancing care coordination and improving patient outcomes.
ICNs and ACOs encompass various healthcare settings to deliver coordinated and integrated care. These include hospitals, primary care clinics, behavioural health centres, social care and speciality clinics, and other healthcare facilities. Hence, a key criterion for IT systems buyers is that a system-wide HIE must leverage data available across all healthcare settings within an ICN or an ACO.
Across settings, a system-wide HIE can leverage several data sources, including EHRs, Clinical Information Systems (CISs), lab data, pathology reports, Computerised Physician Order Entry (CPOE) and other clinical information sources. These systems provide the highest level of clinical depth available. However, as standalone solutions, the data is siloed, and obtaining a complete picture of a patient’s health is challenging. In many cases, multiple EHRs are used in different settings across an IDN or ACO. So not even the EHR data is unified. Hence, buyers look for HIEs that can integrate data from disparate clinical IT systems to be used within their different healthcare settings.
Furthermore, buyers say HIEs must also be connected to US insurance providers’ data as this has the potential to provide the most comprehensive individual patient health stream. The insurer will see the services provided to the patient across all settings in an IDN and services delivered by third parties outside an IDN, assuming the patient hasn’t changed insurance provider. Hence in theory, if you have a comprehensive connection to the payer, it can give you a full view of the patient’s history, overcoming the siloed nature of the clinically available data. Although payer data is broad, it lacks clinical depth, as it is mostly about billing and suffers from latency issues. However, it encompasses a comprehensive healthcare stream and can provide an in-depth view of a patient’s health if integrated with clinical data.
Buyers of IT systems seeking HIE solutions also require information on SDoH, encompassing socioeconomic factors, education, employment, housing, access to healthcare, and social support networks. While this data is non-clinical and unrelated to healthcare, it offers valuable insights into a population or individual patient’s circumstances. This information can inform healthcare providers on how to better support and manage their patients based on broader social elements, supplementing traditional healthcare data.
Buyers also expect their network-centric HIEs to be interconnected to the state-wide HIEs that have been in place for several years. However, data available regionally is often not clinically comprehensive and may suffer latency issues. Additionally, several state-wide HIEs within the same regions are creating disparate HIE systems that limit their usefulness. For example, over ten state-wide HIEs are in place in Texas and California. Although once fully integrated, the information available across state-wide HIEs can provide a more comprehensive understanding of the population.
Currently, existing HIE systems cater to only a few requirements, and no ideal solution assimilates all relevant data points. IT buyers need solutions that effortlessly accommodate broad and detailed data inputs from diverse sources.
Exchanging Information – Exchanging Frustration
Most IDNs and ACOs have a network-type solution in place. This is unsurprising given that, to function as an IDN or ACO, you need a solution that enables visibility across the network. But these solutions typically need improvement in several areas to become desired by IT buyers.
First and foremost, solutions must use data from all previously-mentioned sources. IDNs face challenges due to incomplete integration resulting from a lack of interoperability between siloed systems. The healthcare industry has a long track record of creating vendor-specific designs, making it difficult for third-party vendors to develop an application that seamlessly integrates with legacy IT infrastructure. This results in workflow issues for care providers, causing frustration and burnout as extra work is required to pull data in from various sources manually.
Another area for improvement with some HIE solutions is because they may only offer a surface-level summary of patient data rather than providing a complete set of information for a patient. Even if an HIE is in place, it may need to be more comprehensive to capture all relevant (structured and unstructured) patient data across the healthcare ecosystem.
Additionally, the system may have information gaps where specific healthcare settings or systems are not connected to the HIE. In the US, IDNs are expanding by acquiring independent practices and hospitals, and integrating their data is time-consuming. Hence, sometimes not all parts of the IDN feed in through its system-wide HIE, rendering it less helpful.
Furthermore, buyers indicated latency as a limitation of current HIEs. Low data refresh rates mean HIEs are rarely used in real-time, at point-of-care situations. It has also been noted that patient information needs to be updated, including names, identification codes, and contact information.
Historically, a lack of standardisation has held the market back. HIEs did not provide a complete set of solutions required by health network operators, as disparate systems could not communicate. This is being addressed with standards such as Fast Healthcare Interoperability Resources (FHIR), which provides a standardised and flexible healthcare data exchange framework. In addition, the 21st Century Cures Act is forcing providers towards standard-based interoperable solutions.
Lastly, HIEs currently offer tools to compile a comprehensive data lake. However, the utilisation of this information in real-time workflows still needs to be addressed. Therefore, the benefits of these processes have yet to be fully realised.
Picking the Perfect Puzzle Pieces
Our interviews with HIE solutions buyers reveal that compliance with the FHIR framework and standardisation is their priority. This is expected since it enables interoperability, data integration, and care coordination between healthcare systems. Standardisation facilitates efficient exchange of patient data, improves PHM, enhances treatment quality, patient outcomes, and the overall effectiveness of healthcare organisations and networks.
To meet diverse buyer needs, HIE solutions must be adaptable and include features such as Open APIs. In terms of the analytics and workflow tools that leverage the HIE data, in the interviews, we found that certain healthcare providers preferred self-developed/DIY solutions. Others were interested in commercial off-the-shelf (COTS) applications. The mixed responses suggest that HIE solution vendors must develop HIEs that include pre-built tools to employ data and flexibility to enable healthcare professionals and third-party vendors to build additional tools to analyse HIE data.
A notable emerging trend is a growing interest in accessing data from LHRs and seamlessly integrating it with the EHR environment. Healthcare network buyers anticipate that clinicians will continue relying on the EHR as the primary tool for real-time, point-of-care scenarios. Therefore, surfacing a view of the LHR from within the EHR will be highly effective in improving patient outcomes.
When searching for a system, buyers require comprehensive information. However, it’s crucial to have efficient tools that can filter through the data and present only the information pertinent to each user’s specific role. The aim is to prevent overwhelming general practitioners or clinicians with unnecessary details and only giving crucial data to them. Even if it’s not a built-in feature of the HIE system, integrating a filtering application into the system is highly desired.
One crucial factor that HIE solution purchasers look for is a fast refresh rate. Older HIEs typically refresh daily, taking at least several hours to update. At least an hourly refresh rate is necessary to support many desired applications with more rapid refresh rates for more real-time point-of-care applications.
When all mentioned conditions are fulfilled, HIEs can substantially influence the healthcare system and enhance processes in various domains. The areas where a well-established HIE system could create the most significant positive impact, as stated by IT solution purchasers, are summarised below:
Cracking the Code
Through our conversations with HIE solution buyers, it is clear that there is a significant need for HIEs to pull in information from various sources and healthcare settings and have the functionality to pull data from other system-wide and state-wide HIEs. Buyers also want an HIE solution that offers flexibility in providing data analytics by offering both pre-built tools and Open API-type solutions to allow for COTS analytics and in-house developed solutions.
In addition, the HIE needs to integrate information back into setting-specific EHR systems as EHR will continue to be the application for real-time clinical use. The HIE system pulls in a wide range of data; buyers of this solution require a filtering tool to provide information based on the type of user accessing it.
From the technical standpoint, buyers want technology that is interoperable with other solutions and uses open standards such as FHIR. Buyers also need solutions that have faster refresh rates to assist them in point-of-care applications.
To enhance the overall health outcomes of individuals and the wider population, software vendors must strategically address the pain points while prioritising the needs of both patients and care providers in their product development.
This approach is crucial in achieving success.
Related Research: Health Information Exchange – World – 2024
Signify Research is set to release a comprehensive report titled “Health Information Research – World – 2024“. This report will offer a detailed and worldwide analysis of the HIE market. It will feature primary data gathered from extensive interviews conducted with healthcare experts and technology vendors, providing an unbiased and well-rounded view of the market.
About Vlad Kozynchenko
Vlad joined Signify Research in 2023 as Senior Market Analyst in the Digital Health team. He brings several years of experience in the consulting industry, having undertaken strategy, planning, and due diligence assignments for governments, operators, and service providers. Vlad holds an MSc degree with distinction in Business with Consulting from the University of Warwick.
About the Digital Health Team
Signify Research’s Digital Health team provides market intelligence and detailed insights on numerous digital health markets. Our areas of coverage include electronic medical records, telehealth & virtual care, remote patient monitoring, high-acuity clinical information systems, patient engagement IT, health information exchanges and integrated care & value-based care IT. Our reports provide a data-centric and global outlook of each market with granular country-level insights. Our research process blends primary data collected from in-depth interviews with healthcare professionals and technology vendors, to provide a balanced and objective view of the market.
About Signify Research
Signify Research provides healthtech market intelligence powered by data that you can trust. We blend insights collected from in-depth interviews with technology vendors and healthcare professionals with sales data reported to us by leading vendors to provide a complete and balanced view of the market trends. Our coverage areas are Medical Imaging, Clinical Care, Digital Health, Diagnostic and Lifesciences and Healthcare IT.
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