Billions of dollars are being granted, gifted, and invested in Health Information Exchanges (HIEs) across the country. A previous Commonwealth Study that appeared in the Annals of Internal Medicine estimated $178 billion will be needed to create regional and national networks.
With all that said, very few Health Information Exchanges (HIEs) have achieved a business/operating model that is sustainable without significant ongoing grants and subsidies.
In my opinion there are three keys to creating a sustainable HIE:
- Understand perceived value in the minds of likely participants
- Focus on achieving critical mass
- Live operational excellence.
Understand perceived value in the minds of likely participants
Perceived value is how each individual organization believes they will benefit from participating in a Health Information Exchange, relative to what the Health Information Exchange fees are.
Large amounts of data exist around quantifiable savings; for instance, reduction in duplicate lab tests, or avoiding adverse drug events. Population statistics and studies, ROI analyses, and demonstration projects all suggest that we all stand to gain from HIEs.
However, each individual organization interprets, believes, and acts on that data in different ways. Organizations, from a large academic medical center to a small physician practice, perceive the value differently, and therefore, have differing perspectives on what they are willing pay. This is perceived value…. What do I believe is the value to me in the context of my unique circumstances.
Understanding perceived value across key demographics allows HIEs to provide a mix of complimentary services, over and above their core service offering, that aligns closely with key constituents. How many physicians are using ePrescribing? How are lab tests being delivered? Are claims being submitted electronically? Each question has a value proposition, and across the healthcare ecosphere, they are all being approach at differing levels, for differing reasons.
At a very simple level, provide relevant services for your customers and they will pay for it.
Focus on achieving critical mass
Critical mass is also a very important concept and must be part of a sustainable HIE’s core business strategy. Much of the perceived value to physicians is having access to complete data sets for patients that can improve the timeliness, accuracy and efficacy of treatment decisions.
As with electronic health records, physicians will not use an electronic health record in lieu of a paper health record unless they believe it is complete enough to be advantageous in terms of time and quality of their workflow. The same applies to a HIE. Why would a physician access a HIE unless they were convinced that the vast majority of the time, the data will be there.
Furthermore, if they access the patient record and the medication history, or lab results are not complete, then a physician will not rely on the data from the health information exchange to make clinical decisions. Missing data then suggests even the data present may be incomplete, therefore not worth the time, effort, and costs to review.
Frankly, without very strong adoption by physicians, a health information exchange provides minimal perceived value to other entities who pay for health care services, have much to gain from a successful HIE, and the financial means to contribute to the HIE’s sustainability.
Bottom line, critical mass is an imperative for a successful HIE.
Live operational excellence.
Operational excellence almost goes without saying. You can have a great value proposition, pricing can be spot on, and participants are adopting at high rates, but, if you don’t focus on operational excellence, then participants will eventually ask the question, why are we paying for the service. Always on, accurate data, fast response times, strong help desk, and anticipating future needs all go a long way to ensuring long term, happy customers.
And at the end of the day… happy customers are what make any business sustainable.
