eHealth Initiative Releases Results From 2008 Survey on Health Information Exchange

Survey Links Health IT to Lower Cost and Improved Outcomes

WASHINGTON DC (September 11, 2008) The exchange of health information electronically between physicians, hospitals, health plans, and patients is decreasing the cost of care and improving outcomes, according to a new survey released by the non-profit eHealth Initiative today. The 2008 Fifth Annual Survey of Health Information Exchange at the State and Local Levels, which included responses from 130 community-based initiatives in 48 states, shows the significant impact fully operational initiatives are having on improving health care delivery and efficiency.

CLICK HERE TO DOWNLOAD A PDF VERSION OF THE 2008 SURVEY FINDINGS

Summary of Key Findings

 STATE OF THE FIELD: SURVEY RESULTS INDICATE CONTINUED PROGRESS

• The number of operational health information exchange initiatives has increased considerably. The 2008 survey results indicate 42 operational health information exchange initiatives—up from the 32 reporting in 2007—indicating a 31% increase. All 32 operational health information exchange initiatives who responded in 2007 continue to be in operation in 2008.
• The 2008 survey counts 18 new health information exchange initiatives.  Eighteen new health information exchange initiatives not included in the 2007 survey reported findings in 2008, demonstrating increased interest in and momentum for the use of health information exchange to improve the quality, safety and efficiency of health care in the U.S.
• The number of health information exchange initiatives in each phase of development are evenly dispersed. Thirty-nine of the initiatives included in the 2008 survey are just getting started with health information exchange, 36 are in the process of implementation, and 42 are operational.
• State and local health information exchange efforts continue to view the engagement of multiple stakeholders as a priority. 2008 survey results indicate continued strong participation by providers, payers, patients and public health. 
• The most significant challenge for all efforts continues to be the development of a sustainable business model. Eighty-two percent of all 130 respondents cited this as a very difficult or moderately difficult challenge. Seventy-two percent of the 42 operational initiatives also cited this as a very difficult or moderately difficult challenge.

IMPACT ON HEALTH CARE: 2008 RESULTS INDICATE GROWING IMPACT ON LOWERING COSTS AND IMPROVING CARE

• A majority of the fully operational exchange efforts (29/42) report reductions in health care costs. Sixty-nine percent of 2008 respondents say health information exchange allows them to either decrease dollars spent on redundant tests; reduce the number of patient admissions to hospitals for medication errors, allergies or interactions; decrease the cost of care for chronically ill patients; or reduce staff time spent on administration. To read about how one operational health information exchange initiative reduces costs, click here.
• About half of fully operational exchange efforts (22/42) report positive impacts on health care delivery. Fifty-two percent of 2008 respondents report one or more of the following positive impacts: a decrease in prescribing errors; improved access to test results; improved compliance with chronic care and prevention guidelines; better care outcomes for patients; increased recognition of disease outbreaks; or improved quality of practice life.
• For the first time, a majority (69%) of operational exchange efforts (29/42) report a positive financial return on their investment (ROI) for their participating stakeholders. Thirteen operational initiatives reported they were able to quantify an ROI for hospitals, nine reported an ROI for physicians practices, six reported an ROI for health plans, and five for independent laboratories. To read about how one operational health information exchange measures ROI, click here.

PRIMARY FOCUS ON CARE DELIVERY, BUT INCREASING FOCUS ON IMPROVING POPULATION HEALTH

• As in previous years, health information exchange initiatives are continuing to focus their efforts on supporting direct care delivery. 2008 survey results show that 26 of the 42 operational initiatives are offering clinical messaging, results delivery, or clinical documentation as one of their services.  Sixteen are providing either alerts to providers, consultation/referral services or enrollment or eligibility checking. Click here to read about an initiative that transmits clinical data.
• In addition to improving care delivery, tackling population health challenges continues to be a goal of many operational health information exchange efforts. Ten of the 42 operational initiatives are offering disease or chronic care management services, eight are offering quality improvement reporting for clinicians, six are offering public health reporting, and five are offering quality improvement reporting for purchasers or payers. To read how one health information exchange initiative is improving population health, click here.
• The variety and volume of data being exchanged increased significantly from 2007 to 2008. In 2008, a total of 26 operational initiatives reported that they are exchanging laboratory results, up from 19 in 2007 and 23 are exchanging outpatient episodes up, from 21 in 2007. In addition the number of operational initiatives exchanging radiology results (23), inpatient episodes (22), dictation/transcription data (20) and emergency department episodes (20) all increased from 2007. 

FINANCING CONTINUES TO BE A CHALLENGE

• In addition to developing a sustainable business model, securing upfront funding is a significant challenge for all health information exchange efforts. Seventy-nine percent of the 130 efforts reporting in the 2008 survey cite that securing upfront funding with 79% citing this as a very difficult or moderately difficult challenge. 
• Hospitals and the federal government top the list as the most prevalent upfront funding source for operational health information exchange efforts. Forty-eight percent of operational efforts received upfront funding from hospitals and a similar percentage received funding from the federal government, followed by 33% from state government, 26% from private payers, and 24% from philanthropic sources. 
• Operational health information exchange initiatives are no longer dependent on federal funds. Seventy-one percent of the 42 operational health information exchange initiatives who responded to the 2008 survey communicated that they were no longer reliant on federal funds to support their sustainability. This is up from the 56% in 2007.
• Hospitals also topped the list for providing financial support for ongoing operations. Sixty-two percent of operational health information exchange initiatives are receiving funds from hospitals to support ongoing operations, followed by physician practices (38%), the federal government (36%), private payers (29%), state government (26%), and public payers (24%).

A report of this breadth would not be possible without the contributions of many individuals and organizations. Enormous thanks go to Jennifer Covich Bordenick, eHealth Initiative Foundation vice president and John Mellin, program manager, who played a considerable role in developing and fielding the survey and writing the report. Our sincere thanks also go to the co-chairs of the Connecting Communities Workgroup Micky Tripathi, PhD, President and Chief Executive Officer Massachusetts eHealth Collaborative, and J. Marc Overhage, MD, PhD of Indiana Health Information Exchange. Finally, special thanks also go to InterComponentWare AG, which helped provide support for this work.