HIE Formation Part IX: HIE Consolidation – One Route to Sustainability

By Laura Kolkman, RN, MS, FHIMSS, and Bob Brown

In this series of monthly articles, based in part on their recently published book, the authors discuss current HIE related events and leading practices within the context of forming an HIE initiative in your state, region or community. This series of articles was launched in the March 2011 issue of HIELights.

In August of this year, we learned about the merging of the Minnesota Health Information Exchange (MN HIE) into an exchange created by the Community Health Information Collaborative (CHIC). This was done to save on costs and avoid duplication of efforts.

In early October, it was announced that the Adirondack Regional Community Health Information Exchange (ARCHIE) merged operations with the Health Information Xchange of New York (HIXNY). A few weeks later, the Kansas Health Information Network (KHIN) and eHealthAlign also merged their technology contracts, enabling a standardized approach for managing their technology infrastructure with the expectation of gaining efficiencies from economy of scale.

In our book The Health Information Exchange Formation Guide, we identified five stages in the maturation of an HIE: Initiation, Formation, Operation, Optimization, and Consolidation.  Even though most exchanges are still in the Formation or early Operational stages, we’re now seeing clear evidence of Optimization and Consolidation.

Consistent with our predictions, we believe that these instances are just the beginning for the consolidation of HIEs and are merely a result of HIEs’ natural progression. In order for HIEs to elevate themselves in to the Optimization and Consolidation stages, we strongly believe that initial HIE formation efforts must remain local – at least for now.

HIEs need to be formed locally to garner the necessary support of their communities’ providers, healthcare systems, and patients. That’s because forming an HIE is all about relationships and trust. And, at least for now, trust still needs to be established locally.

However, sustainability remains elusive. It depends on those all important issues of stakeholder engagement and participation. As HIEs mature, they must build on stakeholder involvement and continually seek economies of scale to be successful.   That can be accomplished through an expansion of their geographic coverage, market, services provided, or otherwise by mergers and consolidation. We’ve already seen some HIEs be successful with an expansion of their market or services, but while HIEs are expanding, we believe that HIEs consolidating for sustainability is more of a pervasive trend.

As HIEs consolidate, it remains crucial that they retain and nurture the trust of their original stakeholders by involving them in the process. It’s reasonable and prudent to consolidate back office operations to gain efficiencies and keep costs down. It’s quite another thing, however, to consolidate governance. 

The key challenge for consolidating HIEs will be to maintain the stakeholder trust they have worked so hard to obtain.

Laura Kolkman, RN, MS, FHIMSS, is the president of Mosaica Partners and Bob Brown is the vice president of Professional Services. Their book, The Health Information Exchange Formation Guide, was published by HIMSS in February.  HIMSS’ companion website, where you can read chapter summaries and download select tables, figures, illustrations and checklists, is available at www.himss.org/hieformationguide.