A Survey of Health Information Exchange Organizations in the United States: Implications for Meaningful Use

BACKGROUND To receive financial incentives for meaningful use of electronic health records, physicians and hospitals will need to engage in health information exchange (HIE). For most providers, joining regional organizations that support HIE is the most viable approach currently available. OBJECTIVE To assess the state of HIE in the United States through regional health information organizations (RHIOs). DESIGN Survey. SETTING All RHIOs in the United States. PARTICIPANTS 179 U.S.-based RHIOs that facilitated HIE as of December 2009. MEASUREMENTS Number of operational RHIOs, the subset of operational RHIOs that supported stage 1 meaningful use, and the subset that supported robust HIE; number of ambulatory practices and hospitals participating in RHIOs; and number of financially viable RHIOs. RESULTS Of 197 potential RHIOs, 179 (91%) reported their status and 165 (84%) returned completed surveys. Of these, 75 RHIOs were operational, covering approximately 14% of U.S. hospitals and 3% of ambulatory practices. Thirteen RHIOs supported stage 1 meaningful use (covering 3% of hospitals and 0.9% of practices), and none met an expert-derived definition of a comprehensive RHIO. Overall, 50 of 75 RHIOs (67%) did not meet the criteria for financial viability. LIMITATIONS Survey data were self-reported. The sample may not have included all HIE efforts, particularly those of individual providers who set up their own data-exchange agreements. CONCLUSION These findings call into question whether RHIOs in their current form can be self-sustaining and effective in helping U.S. physicians and hospitals engage in robust HIE to improve the quality and efficiency of care. PRIMARY FUNDING SOURCE Office of the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services.