Many health information exchanges (HIEs) are facing a questionable financial future. Those federally funded, especially, are up against critical deadlines as their grants are about to expire in October, and budgeted state funding should dry up within a year after that. Without this outside financial support, the survival potential of many of the still-nascent HIEs is uncertain. Here’s the conundrum: this uncertainty is hindering stakeholder involvement and investment, among the most important elements to long-term growth.
Working with HIEs, states and other stakeholders for the past several years has revealed key actions on which grant-funded HIEs should focus to pave the way toward a not only a viable, but also a prosperous future:
1. Prepare for a rapid shift to an entrepreneurial business mind-set.
Successful HIEs will need to quickly change gears from checking the federal government boxes and grantsmanship to new, entrepreneurial ways of doing business. The mind-set and business modus operandi for grant-funded enterprises are very different from those relying on conventional business models.
For example, activities of grant-funded entities tend to be narrowly and inwardly focused, such as writing proposals for specific agencies, responding to their timelines for reports, generating letters of stakeholder support and meeting the near-term needs of the small number of stakeholders typically encompassed in the scope of a grant. Those using conventional business models are more outwardly focused to create market share, develop competitive advantages and generate multiple, recurring revenue streams that respond to the expectations of shareholders and the markets. The cultural transition from grant funding to outside funding must be planned for and managed.
2. Identify opportunities for "disruptive innovations."
HIEs have the opportunity to be disruptive innovators in the healthcare environment. That is a good thing. Disruptive innovation describes transformations undertaken by industries to provide customers with increasingly affordable and accessible products and services. For HIEs to “disrupt” the traditional ways of doing business and improve healthcare, they must leverage technology, add value and innovate. This means they must find new ways of sharing data at lower cost, more efficiently, with more people and in more places.
An example of a disruptive HIE innovation is the new imaging service being piloted by Maine’s HIE, HealthInfoNet. The pilot will be the first in the nation to support statewide sharing of x-rays, computed tomography scans and other medical images through the HIE. In addition to providing access to medical image reports, Maine physicians will also have instant access to the actual images themselves, rather than wait for image copies to be sent on disks or other means.
The pilot additionally will create an archive that includes five years of previous images, and is expected to generate about 1.8 million new medical images containing more than 45 terabytes of data annually. By consolidating medical images into a single archive, Maine healthcare providers are expected to save some $6 million over seven years by reducing image storage and transport costs.
3. Act on identified entrepreneurial and disruptive opportunities.
An entrepreneurial team seeking disruptive innovations lays the foundation for an alchemy of growth that is centered on getting ahead of the curve by helping the HIE's community thrive in the new world of value-based care. Only an HIE can effectively deliver the infrastructure needed to coordinate care across the continuum and proactively manage a defined population's health.
The successful HIE will view its services as a portfolio to manage and grow. It will then aggressively expand that portfolio by moving beyond the basic HIE services of results delivery and transport of clinical documents. The expanded portfolio will provide such value and innovation as a patient registry service, quality data analytics, medication reconciliation and health risk assessments. By focusing on disruptive innovations that fill the gaps left by most electronic health records, an HIE becomes essential to the strategies and operations of healthcare providers in its community.
To be sure, HIEs are looking for that sweet spot between the mythical “perfect solution” and the “quick fix” for financial viability. However, there is no secret sauce for universal HIE growth and sustainability.
Edited by
Alisen Downey
