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Clinical integration knowledge hub

Learn about the importance of implementing a successful clinical integration strategy, along with some obstacles to avoid along the way.

Are Health Information Exchanges the path to clinical integration?

Ideally, a Health Information Exchange (HIE) enables caregivers and patients to store and access patient information through a shared data repository. But while HIEs can improve the exchange of patient information, their model is insufficient for achieving true clinical integration.

There is no lack of HIEs nationwide—as of 2012, there were more than 250 active electronic Health Information Exchanges, including 56 grantees of the Office of the National Coordinator (ONC) State HIE Cooperative Agreement Program.1

But there’s an unfortunate issue with state-funded HIEs, who typically rely on grants and public funding: They’ve been slow to develop financial sustainability. Yet, the need for electronic patient information exchange continues to grow.

As a result, private Health Information Exchanges have proliferated. By investing in a private HIE solution, hospitals and physician organizations may have more control over the exchange’s design and implementation, and may worry less about sustainability because the business model only applies to their specific environment. But with private HIEs, the concern about financial sustainability remains.


  • High up-front costs with no clear return on investment (ROI)
  • Requirement of a large number of participants to be effective
  • May not be aligned with the goals of the clinically integrated organization
What’s more, there are widespread concerns about the interoperability of private HIEs. For example, a 2012 survey by the eHealth Initiative concluded that HIEs developed for one organization may not be able to communicate with exchanges outside of the provider community for whom it was developed. Therefore, and unfortunately, complete and easy access to health data may not be possible among all private HIEs.2

From the caregiver point-of-view, providers are not convinced that Health Information Exchanges provide complete, accessible, secure patient information. Some HIEs function as larger “islands” of data, which may or may not connect all relevant care providers. A 2012 study by the Bipartisan Policy Center (BPC) reported that 71 percent of clinicians surveyed thought the lack of interoperability and the lack of HIE infrastructure were major challenges.

Additional findings from this study:
  • A majority of clinicians (69%) cited the associated costs of developing and maintaining interfaces and exchanges as a barrier to exchanging information with other providers
  • Twenty-five percent of clinicians cited privacy and liability concerns as barriers to exchanging health information
  • When receiving health information from an outside clinician or practice, 57% of clinicians say they prefer to “pick and choose” which information they want to include in their electronic health record (EHR), compared to only 16% who prefer to upload and include all the information.3
Another study concluded that barriers to using Health Information Exchanges were cost, privacy and liability concerns, and technical barriers. And a positive return on investment could not be documented.4

The HIE is an attempt to effectively exchange information across systems, and the landscape will continue to evolve. Whether or not your organization participates in a public HIE or builds its own, it is a mistake to assume that HIEs alone will help achieve clinical integration.

To make effective health information exchange a long-term, sustainable goal, consider the following recommendations from the eHealth Initiative:

  • Define a vision for your organization’s participation in HIEs or other information exchange programs that stakeholders and physicians can buy into
  • Create a viable governance entity and engage the provider community
  • Develop a sustainability model based on the needs and resources of the community, taking into account the significant costs associated with connecting to or building an HIE
  • Identify value by determining the most essential functions of the HIE based on the needs of providers within the community and enable those within the exchange
  • Ensure continuity with the workflow of a hospital or physician practice with limited interruptions
  • Work with public HIEs because it is important that all systems work together to enable data exchange between networks and across state boundaries.5

1 eHealth Initiative. 2012. The Rise of the Private Health Information Exchange and Changing Role of Public Exchanges.

2 Brian T. Horowitz. Nov 16, 2012. Private HIE Growth Could Hinder Health Care Data Compatibility. Available at:

3 Bipartisan Policy Center. Oct. 3, 2012. Accelerating Electronic Information Sharing to Improve Quality and Reduce Costs in Health Care. Available at:

4 Patricia Fontaine, MD, MS, Stephen E. Ross, MD, Therese Zink, MD, MPH and Lisa M. Schilling, MD, MSPH. Systematic Review of Health Information Exchange in Primary Care Practices. J Am Board Fam Med September-October 2010 vol. 23 no. 5 655-670. Available at:

5 eHealth Initiative. 2012. The Rise of the Private Health Information Exchange and Changing Role of Public Exchanges.

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