MSP Opportunities in Health Information Exchanges

Heath information exchanges, or HIEs, have been creating opportunities for technology and service providers able to navigate tricky interoperability issues. HIEs aim to distribute clinical information among healthcare providers. The goal: orchestrate patient care across providers that typically operate in electronic isolation. In recent years, HIE activity has been concentrated in state and regional HIEs. Finding viable business models, however, has proven difficult and several efforts have failed. But there is opportunity for small IT service providers here.

Against that backdrop, Chilmark Research reports a shift in the HIE market — from state and large public HIEs to exchanges that serve healthcare organizations of all sizes. Chilmark Research, in its 2012 HIE Market Report released earlier this month, describes this broader customer set as the enterprise market.

That market encompasses a range of HIE types. An exchange could be a localized linkup among a couple of hospitals and affiliated physicians. Or it could be a group of hospitals and doctors in a somewhat larger geographic area. The upshot for MSPs: smaller-scale HIEs could make the market more accessible to smaller service and solution providers.

“Smaller vendors have an opportunity in this market,” said John Moore, founder and managing partner at Chilmark Research. “The barriers to entry are much lower than was the case with state and large public HIEs.”

Private Healthcare Information Exchanges Growing Fast

An earlier report from KLAS, a research firm focusing on healthcare vendors, reinforces this notion. KLAS reported the the number of private HIEs more than tripled from 2010 to 2011. Public HIEs continued to grow, according to KLAS, but at a lower rate.

So, while large, regional HIEs were once the expected pattern, their more diminutive counterparts find themselves on the faster growth track.

Jordan Battani, managing director for CSC Global Healthcare Group, said she has encountered more variety in HIEs’ organizational models. She said the smaller regional variations are trying to put together a mechanism that ensures interoperability across the continuum of care — from the primary care physician on one end to rehabilitation services and skilled nursing on the other.

“That is where information exchange is a critical enabler for linking together the information systems and the knowledge across all those disparate entities and different systems,” Battani said.

The emergence of Accountable Care Organizations (ACOs), networks of doctors and hospitals that provide care coordination for a group of Medicare patients, has helped propel the rise of private HIEs.

Moore said the move to value-based models — such as ACOs and Patient-Centered Medical Homes — force healthcare organizations to adopt HIEs. He said exchanges provide the only way to manage transitions in care when the local market is characterized by heterogenous electronic health record (EHR) system deployments.

The Challenge of Integration

Hospitals and physicians typically run a mix of different systems. And Battani pointed out that even healthcare organizations using the same EHR vendor, may each deploy the software in a different way. EHR applications and associated tools are highly configurable, she noted.

Beyond ACOs, the second stage of the federal government’s meaningful use EHR adoption program also contributes to the increase in localized HIEs. Stage 2 criteria call for hospital and physicians to electronically distribute patient care summaries to other providers and across other EHRs.

Healthcare organizations dealing with ACOs and meaningful use as drivers may seek to quickly establish local exchanges, rather than count on a statewide or large regional HIE.

In such an environment, healthcare MSPs have a shot at building and/or managing HIEs that help healthcare entities coordinate care. They may also find the much sought after trusted advisor role as they help healthcare customers determine the best path to an exchange.

In addition, service providers could be in a position to help the smaller, localized HIEs join forces down the road.

“In the end, the value of information exchange is the ability to create a seamless utility-like service for passing information back and forth … across a wide continuum,” Battani explained. “If we have a whole bunch of small ones, it suggests to me that there would need to be some next wave of consolidation at some point in the future.”