Differing Strategies to Meet Information-Sharing Needs: Publicly Supported Community Health Information Exchanges Versus Health Systems’ Enterprise Health Information Exchanges

Abstract

Policy Points:r Community health information exchanges have the characteristics of a public good, and they support population health initiatives at the state and national levels. However, current policy equally incentivizes health systems to create their own information exchanges covering more narrowly defined populations.r Noninteroperable electronic health records and vendors' expensive custom interfaces are hindering health information exchanges. Moreover, vendors are imposing the costs of interoperability on health systems and community health information exchanges.r Health systems are creating networks of targeted physicians and facilities by funding connections to their own enterprise health information exchanges. These private networks may change referral patterns and foster more integration with outpatient providers. Context:The United States has invested billions of dollars to encourage the adoption of and implement the information technologies necessary for health information exchange (HIE), enabling providers to efficiently and effectively share patient information with other providers. Health care providers now have multiple options for obtaining and sharing patient information. Community HIEs facilitate information sharing for a broad group of providers within a

The implications and impact of 3 approaches to health information exchange: community, enterprise, and vendor‐mediated health information exchange

“…Development may be a competitive advantage because it can provide efficiency gains to providers within a large organization or can tie loosely affiliated outside healthcare organizations closer to the organization. 13,31 Vendor EHR vendors may find it in their competitive interest to facilitate HIE within their customer base, the vendors may also block information sharing with healthcare organizations using other vendors to increase the appeal of selecting their system. 32…”

Challenges to Conducting Health Information Exchange Research and Evaluation: Reflections and Recommendations for Examining the Value of HIE

“…For example, Enterprise HIEs predominately leveraging DIRECT Secure Messaging do not enable population health analytics, yet community HIEs that store data in a central repository can support research efforts. 32,33 Nevertheless, despite variation, the experiences of our sample of evaluators were similar. As a research community, we do not have either a good handle on this variation, nor a clear method of categorizing this information.…”

A population ecology perspective on the functioning and future of health information organizations

“…Likewise, when multiple HIOs exist within a market, hospitals often only participate with one organization (Vest, 2016). Additionally, HIO leaders report that community HIOs and enterprise HIEs compete for hospital resources and attention (Vest & Kash, 2016).…”