HealthyIT

The adoption of Health information exchanges (HIE) is hobbled by the difficulty of creating a viable business model in the the fragmented landscape of health care in the United States. This fettering is apparent in the adoption of informatics technologies such as telelhealth. Adoption of telehealth results in a costs savings due to decreased transport, better patient follow up, and efficiently distributing specialty care (1,2). A recent study demonstrated that a nationwide adoption of telelhealth in emergency rooms, prisons, nursing home facilities and physician offices would save the health care system over 4.3 billion dollars(1). A similar 2005 study showed adoption of an standardize nationwide HIE would results in savings of 77.8 billion per year once fully implemented (3). Unfortunately in the fragmented landscape of US health care there is no single health care entity. Thus, the difficulty in adopting technologies such as telehealth or HIE lies in a health system with multiple actors each with different interests and agendas all trying to minimize costs and often times increase profitability so that the initial investment in such technologies by a single actor becomes a difficult pill to swallow (4).

Private sector telelhealth companies such as American Well have flourished because their business model relies on a partnership with private insurance companies (5). This allows for the adoption of telelhealth technologies without a cost burden to patients or physicians. Wright et. al. while discussing HIE adoption state that “finding a sustainable business model is a key challenge for existing and proposed HIOs some of which depend on subscription fees from physicians” (6) . This places the burden on a single actor in the system. In this study physicians became less enamored with the adoption of an HIE when a monthly cost of $150 was required for their participation. Following the example of companies like American Well, HIE adoption will move forward through partnerships: creating a business model where private companies, hospital systems, and insurance companies share the cost burden of implementing the system since they all will benefit.

References:

1. Cusack CM, Pan E, Hook JM, Vincent A, Kaelber DC, Middleton B. The value proposition in the widespread use of telehealth. J Telemed Telecare. 2008;14(4):167–8.

2. Demaerschalk BM, Miley ML, Kiernan T-EJ, Bobrow BJ, Corday DA, Wellik KE, et al. Stroke telemedicine. Mayo Clin. Proc. 2009;84(1):53–64.

3. Walker J, Pan E, Johnston D, Adler-Milstein J, Bates DW, Middleton B. The value of health care information exchange and interoperability. Health Aff (Millwood). 2005 Jun;Suppl Web Exclusives:W5–10-W5–18.

4. Kaplan R, Babad Y. Balancing influence between actors in healthcare decision making. BMC Health Services Research. 2011;11(1):85.

5. American Well – Partnering with Health Plans [Internet]. [cited 2011 Sep 9];Available from: http://www.americanwell.com/partnering_with_health_plans.html

6. Wright A, Soran C, Jenter CA, Volk LA, Bates DW, Simon SR. Physician attitudes toward health information exchange: results of a statewide survey. Journal of the American Medical Informatics Association. 2010 Jan 1;17:66–70.