Part XII: Public vs. Private HIE?

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

In this series of monthly articles, the authors, based in part on their recently published book, discuss current HIE-related events and leading practices within the context of forming an HIE initiative in your state, region or community. This is Part 12 of the series. You can access previous installments at the HIELights e-newsletter archives.

We’re starting to see more and more mention in the press about private HIEs versus public HIEs.  Here’s what you need to know about those differences; and how the activities in their respective formation stages may differ.

What’s the Difference?

The term “private” HIE generally refers to HIE’s which operate under the governance of an integrated delivery network (IDN) or a single healthcare system.  The term “public” HIE is generally used to describe HIEs which are community-based and are open to, and governed by, participants from multiple organizations.  Public HIEs often rely on grants to help them get established and then require a solid revenue stream to become sustainable.  We believe, the term public HIE can actually be misleading and could connote that these HIEs are always totally funded with public or government money.  That is not usually the case.  A more accurate term might be “community” HIE.  They are open to, and supported by, the community in which they operate.

Why the Trend?

States are making strides in forming and standing up HIEs that are initially sponsored under the State HIE Collaborative Agreement Program under the HITECH Act.  While there are a variety of architectures being implemented, these HIEs are generally open to any entity in the health care community that wants to participate.

With the Affordable Care Act of 2010 (ACA) and its emphasis on shared savings programs, bundled payments and other accountable care activities, we are also seeing a great deal of activity in health care systems to set up and operate HIEs within their organizations.  These so-called private HIEs are an initial step in making information available within an accountable care organization (ACO).  Nevertheless, there are lessons to be gleaned from these endeavors – not the least of which is to understand the private HIE business model.

What’s Different in the Formation Stage?

It’s important to remember that because a private HIE is comprised of entities closely associated with a specific organization, the initial motivation, funding sources and services offered may be very different from those of a typical community-based HIE.  The participants in a private HIE may not have gone through all the important stakeholder identification and engagement activities normally associated with the formation of a public HIE.  That doesn’t, however, mean those activities are completely optional.  It’s always best to know what your stakeholders value.

Whether an HIE is public, private, community- or state-based, the important thing to remember is that the ultimate reason for any sharing of health information is to provide better care to our patients.

Laura Kolkman, RN, MS, FHIMSS is the President of Mosaica Partners and Bob Brown is the VP of Professional Services. Their book—The Health Information Exchange Formation Guide—was published by HIMSS in Februar, 2011. View the HIMSS’ companion web site to read chapter summaries and download select tables, figures, illustrations and checklists.