It’s not surprising that HIE efforts – which include national initiatives and regional and state HIEs – are a work in progress, as the players seek to balance a free market approach with regulatory oversight.

While it’s difficult to predict the future of electronic health information exchanges, Eric Zerneke of Arcadia solutions, a healthcare consulting firm, expects HIEs to evolve much like the worldwide web and financial networks.

“We'll have smaller networks that are localized and provide value to their immediate constituents, linked then to regional exchanges, and then to the nationwide (and potentially world wide) network,” he says. “Standards need to be robust, widely accepted, and widely implemented in order for this to happen.  Most importantly, a business model that pays for the exchanges to operate has to be widely accepted – think of this like the ATM fees charged byATM vendors and banks when you get your funds.”

Dave Caldwell, of Certify Data Systems, a healthcare information technology company that develops interoperability programs for connectivity between healthcare entities, says every physician’s practice should be aware of the following best practices:

• PublicHIEs (federal/state grants) have constituents with varying/divergent interests. Most are cliff-funded with non-sustainable business models.
• Privateexchanges, typically sponsored by a Health System, are growing much faster. Private exchanges have strong business drivers for all parties (incentives and goals to improve patient care in a cost effective manner), and tend to have more interoperability than public exchanges.
• Given the many variations of HIEs, it is best that physicians talk to their peers in the community and learn what is working and what is not working. The HIE value proposition for the physician should be very clear.

In recent months, there has been a shift in the way the very term “health information exchange” is being used and interpreted, according to Julie Dooling of The American Health Information Management Association (AHIMA).

HIE is a verb, not a noun, according to several experts, Dooling says. She is an expert on health information management. “This change in distinction comes as increased focus is being placed on the transaction of sharing information, not necessarily the organization that is exchanging the information.  TheOffice of National Coordinator  (ONC) explains it this way: The NationwideHealth Information Network (NwHIN) is not a physical network, rather a set ofcommon standards, services and policies that allow entities to exchange electronichealth information.”

Oneongoing factors shaping the evolution of HIEs is changing reimbursement models as state HIEs and RHIOs struggle to find a sustainable business model. Doran Robinson, vice president of healthcare transactions at athena health, Inc., predicts that a few will continue to exist but many will be forced to change their role and adopt a model that someone is willing to pay for – “or they will disappear,” said Robinson.

“Governmentwill continue to try to play a role in mediating the exchange of healthcareinformation with limited success. After all, the RHIOs of the 00’s are now theHIEs of the early 10’s – not sure what the next group will be called.”