Monthly Archives: October 2012

The three worst things about state Health Information Exchanges:

A Health Information Exchange (HIE) is defined on Wikipedia as: “..the mobilization of healthcare information electronically across organizations within a region, community or hospital system.” States have been awarded more than half a billion dollars by HHS to build these statewide health information exchanges.

But here are some of the issues:

  1. Many states have spent all of the money they were given by the federal governmentto build the HIE, leaving the only path to sustainability to charge large subscription fees to hospitals for the privilege of connecting to the HIE. Consider this example: According to an internal study by the Sushoo Health Information Exchange, single-provider clinics are spending about $17,000 annually to share records the old-fashioned way. This sounds high, but let’s take their word for it for now. According to the current monthly pricing for “large” hospitals to connect to Arkansas’ SHARE HIE, for example, hospitals would exceed this spend per MONTH. So at 100% efficiency, a “large” (250+ beds) hospital, the HIE would offset this spend for only twelve clinics. For the state run HIE to fall much below 100% efficiency leaves a negative progression looming.
  2. Connecting to an HIE often involves a hospital or provider to indiscriminately dump all of their data (translation: your health information) into a government-run repository exposing healthcare organizations to unnecessary audit risk.
  3. The tracks may not meet – Many state HIEs are built on the assumption that entire greenfield networks must be plumbed to support the massive data load that sharing medical records will require. Does this match the thinking of the National Health Information Network? According to this 2 1/2 year old article, the handwriting has been on the wall for some time.


A possible solution? The NHIN, riding on top of Direct Project, is poised to provide point-to-point sharing of medical records as an economical thin layer of services competing directly with state HIEs. The irony? One government agency obsoleting the other by doing something efficiently. Watch this video to learn more.