The numbers are daunting. Nearly two decades after the advent of community health information networks and more than five years after the Bush Administration starting pushing for electronic health records and health information exchanges, only 28 states have one or more operational HIEs. And operational doesn't mean everyone in a region, much less a state, is active in the HIE.

In a nation of 300 million residents over 3.5 million square miles, there are 193 HIEs in various stages of development, according to eHealth Initiative, a Washington-based industry advocacy organization. By self-attestation, 57 of the HIEs are operational. Most HIEs don't have a sustainable business model, and getting a critical mass of regional stakeholders to cooperate in exchanging their data remains an extremely difficult proposition.

There are other reasons that many observers say HIEs should not be relied on as an anchor of an eventual national health information network, the vast, interconnected system ballyhooed by the federal government. Some argue that a network tantamount in scope - namely, the network of claims clearinghouses - already exists and also could handle clinical transactions. Or, mandated use of data standards and the Continuity of Care Document, a standardized summary of care, coupled with a now-mature Internet infrastructure, could do most of the work that HIEs are supposed to do. In one state where several HIEs are developing, the government is helping fund tests of an alternative model, called health records banks.

On the flip side, fueled by several years of momentum, and recently $300 million in funding via the American Recovery and Reinvestment Act - plus matching state funds - the number of HIEs is growing. One hundred and fifty HIEs responded to eHealth Initiative's survey this year, up from 130 in 2008. The organization then confirmed that 43 HIEs that responded to the 2008 survey but not this year's were still functioning for a total of 193. The 57 reported operational HIEs this year that are actually delivering test results, care summaries and other information was a 36% increase from 2008, which was 31% higher than 2007. And in 2009, 67 HIEs responded to the survey for the first time, compared with 18 a year earlier.

Further, a wide range of HIE models have emerged to meet local needs, and there are several established and proven models to copy. HIEs exchanging laboratory and radiology reports, and outpatient and emergency episodic data, increased significantly in the past year, according to the survey. And hospitals increasingly are realizing that better communication with physicians is good health care and good business, and HIEs can help them link with physicians.

So, does reliance on HIEs to form the network-of-networks mean a national health information network is doomed to fail? Or, are HIEs progressing at good speed and proving to be the model that will work? A story in the December issue of Health Data Management debates the issues.

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