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.