Black Book Releases Research on "The Interoperability Tangle"...HIE Replacements, Middleware and FHIR

Press Release | Black Book Research | April 7, 2016

Black Book Research conducted its annual survey of hospital and health system executives, physician administrators and payer organization IT leaders to identify key interoperability trends and understand the challenges they face in their efforts to exchange patient information with other healthcare organizations.

2,012 provider HIE users and 2,300 payer HIE users, as well as 4,100 prospective HIE users of all user types were polled to understand the importance of interoperability in their strategic planning initiatives, as well as their ongoing and new challenges in areas such as connectivity and data exchange.

Between Q3 2015 and Q1 2016, the survey recorded growing HIE user frustration over the lack of standardization and readiness of unprepared providers and payers. 26% of self-identified connectivity-ready hospitals intend to keep expanding into robust exchanges for value-based payment prospects with primed payers, despite the delays by peer providers to electronically share patient data beyond MU.

“Every stakeholder in the healthcare delivery process cannot establish the infrastructure needed to support interoperability, as evidenced by 83% of physician practices responding and 40% of hospitals, that currently admit they are still in the planning and catch up stages of sending and sharing secure, relevant data, “ said Doug Brown, Managing Partner of Black Book.

Of those still lagging behind in prioritizing interoperability, collectively only 17% place the blame on their organization’s available funding or executive interest level, while 57% place culpability on their HIT/EHR vendors for connectivity defects and silos or data blocking, 20% blame their respective government agencies for slow progress in development and standards. A variety of other and combined forces are found liable by the remaining 6%.

“The misalignment of requirements and protocols has hampered all the stakeholders’ interoperability efforts,” said Brown. “This disorder is ushering in a new replacement revolution, this time for those HIEs failing to meet the expectations of their users, payers and providers alike”.

63% of hospitals & hospitals systems report they in the active stages of replacing their current HIE system, whether private, public, homegrown or EHR-dependent with a variety of options including middleware and more advanced HIE systems. Nearly 94% of payers surveyed intend to totally abandon their involvement with public HIEs and work directly in regions and states to create and/or bolster private enterprise HIEs which more directly meet their needs to facilitate accountable care initiatives with providers.

Doug Brown, Managing Partner of Black Book

“The value-based payment reform concept enabled by a robust HIE requires all stakeholders including physicians, insurers, post-acute care, and diagnostic facilities, not just hospitals to reach the goals of dynamic population health,” said Brown, “Focused, private HIEs also mitigate the absence of a reliable Master Patient Index and the continued lack of trust in the accuracy of current records exchange.”

According to the survey results, 39% of hospitals currently implementing or evaluating private regional networks intend to participating in regionally-centered enterprise HIEs with contracted payers to ensure greater connectivity among the stakeholders with whom they network within a geographic healthcare market. “The challenge of turning silos of medical and financial information into a linked, complete, accurate secure lifetime medical record is still tenuous,” said Brown.

90% of polled hospitals see private HIEs as a potentially more profitable model that can be sustained as the industry evolves faster towards a values-based and outcome-based healthcare delivery and reformed payment model.

Black Book™ also noted that payers have been largely absent in the development of dozens of private HIEs until late 2014 because data sharing was viewed as mainly benefitting providers.

“Public HIEs and EHR-dependent HIEs were viewed by 79% of providers as disenfranchising payers from data exchange efforts and did not see payers not as partners because of their own distinct data needs and revenue models,” said Brown.

However, 88% of hospitals and 95% of payers in Q1 2016 see secure data exchanges where all parties pay a fair share in the development and maintenance is creating a more collaborative trusting relationship.

Since 2013, the number of private HIEs involving a payer/multiprovider collaboration have increased steadily. 60% of providers that year reported they distrust payer guided HIE initiatives. In 2016, 93% of providers are considering cooperative HIE to satisfy the growing need for data particularly to manage complex patients and integrate clinical and financial data sets.

“Progressive payers are moving rapidly into the pay-for-value new world order and require extensive data analytics capabilities and interoperability to launch accountable care initiatives,” said Brown.

In response to alleviate concerns of HIEs with poor connectivity outside their IDNs and hospital systems, interoperability middleware is also a fast growing consideration according to 16% of hospital systems IT leaders with EHR-dependent HIE grievances, in particular.

“The middleware software sits within the data pipeline and translates data from disparate EHRs which shows promise for private HIEs, particularly payer-centric enterprise models,” said Brown. “It creates a business intelligence layer that provides information to all stakeholders in real time.”

Middleware is gaining popularity fast by hospitals using EHR-dependent HIE systems with extremely expensive custom development for data sharing outside the network. Black Book evaluated middleware vendors in an associated Q1 2016 user survey, ranking HealthMark, Zoeticx, and Arcadia Healthcare Solutions highest in satisfaction among new users.

Some vendors have refused to open their HIT and EHR systems to complete bidirectional interoperability and the ONC has not used enough of the hammer to enforce interoperability on EHRs and HIT vendors according to 85% of hospital leaders surveyed, 88% of physicians and 92% of payers participating.

eHealth Information Exchange - Credit Doug Brown LinkedIn PulseIn 2013, 82% of all payers and 60% of participating hospitals agreed that an operational national HIE is at least a decade off. In 2015, 91% of all payers and 74% of providers believe that a robust, meaningful national HIE will now be achievable by 2020 if more private or enterprise HIEs are created and a patient locator system is implemented.

Promises made in the recent interoperability pledge for three core commitments from EHR developers (providing patient access, eliminating information blocking, and implementing federal connectivity standards) won’t be the reason why interoperability succeeds, predicts Black Book’s survey results.

The global healthcare analytics market is projected to grow to $18.4 billion in 4 years (by 2020) and the need for that complex data will propel the interoperability needs of providers and payers. “The only way to accomplish that is robust bidirectional interoperability and that’s what will ultimately force comprehensive interoperability into reality, not government-scripted vendor pledges”, said Brown. “Value based care, payer participation in private HIEs, patient locator systems and analytics will be the real forces that push interoperability ahead next.”

And patients agree on the need for medical data exchanges according to Black Book™. A Q3 2015 survey of recently discharged patients of 70 US hospitals evidenced 94% expressing the desire to have their medical and insurance information held and freely shared electronically among their personal providers and payers.

57% of providers also confirm their beliefs that the whole interoperability industry will evolve by leaps by 2018 if some basic issues are addressed, with or without a vendor pledge. “Progressive FHIR standards can allow EHRs to talk to other EHRs should standard definitions develop on enough actionable data points as we are enter a hectic period of HIE replacements, centering on the capabilities of open network alliances, mobile EHR, middleware and population health analytics as possible answers to standard HIE,” said Brown.

Thrusting HIE system replacements in Q1 2016 according to current provider users are:

97% Potential for data breaches, Privacy & Security issues

93% Cost of Custom Interfaces, Constrained Budgets

90% Lack of connectivity with EHR Centric HIEs

75% Complexity of current HIE Technologies

72% Questionable sustainability of HIE vendors or agencies

Current users ranked HIE vendors as top performers in their specialty theatres of engagement. Ranking first in their respective categories in the interoperability marketplace for 2016 are:

RelayHealth – Core Private Enterprise Platform and Packaged HIE Solutions

Infor – Complex Data Integrators and Outsourced HIEs

Optum – Private Payer and Commercial Insurer Centric HIEs

Medicity – Public/Government and Agency HIEs Systems

Cerner –EHR/HIT-based HIE

Other vendors scored well in specific key HIE performance indicators were: Availity, Allscripts, CSC, Greenway, ICA, Medecision, and QSI Mirth.

About Black Book™

Black Book Rankings, a division of Black Book Market Research LLC, provides healthcare decision makers, IT users, media, investors, analysts, quality minded vendors, and prospective software system buyers, pharmaceutical manufacturers, and other interested sectors of the clinical technology industry with comprehensive comparison data of the industry's top respected and competitively performing technology and managed services vendors in the sector.

The largest user opinion poll of its kind in healthcare IT, Black Book™ collects over 400,000 viewpoints on information technology and outsourced services vendor performance annually. For methodology, key performance indicators utilized, auditing, resources, comprehensive research and ranking data, see

Black Book’s trademarked crowdsourced survey processes additionally employ two external and independent validation software leaders on up to ten points of respondent verification, the only researchers in the healthcare industry to launch mobile, web and live telephone interview polling systems. Black Book founders and employees own no financial interest in the vendors ranked for client satisfaction and loyalty, and receive no incentive from vendors for polled rankings of their customers.