Written by
Cranfield, UK, 5th July 2024, Written by Arun Gill –
The Health Information Exchange (HIE) market exceeded $3bn in 2023, representing healthy revenue growth year-on-year, according to Signify Research’s new HIE market report.
There are four types of HIE being implemented, highlighted in the Figure below. Most are at national, state-wide or system-wide level, with hospital-specific HIEs seeing the least activity due to the trend of them being replaced by larger health systems or regional entities, which are increasingly procuring health IT. Due to security reasons and trust, the majority of HIE implementations make use of de-centralised/federated data architecture, where data passes through from one point to another.
Geographically, all markets witnessed annual revenue growth in local currency terms in 2023. The US is the world’s most mature HIE market, accounting for almost 60% of global revenues. In Europe, national initiatives and substantial hospital IT funding have fuelled regional/state-wide and system-wide HIE developments across several geographies. There are some very sophisticated markets in Central and Latin America, parts of Southeast Asia and Eastern Europe, however paper- and fax-based systems still rule in many cases. Most of these markets at least have interoperability/HIE frameworks and initiatives in place, which are expected to drive progress in the next five to 10 years.
Market Drivers
National and Regional Initiatives
National initiatives and substantial hospital IT funding have fuelled regional/state-wide and system-wide HIE developments. Examples within the EMEA region include ICS/ICB initiatives in the UK, Italy’s regional procurement and FSE rollout, France’s Ma Sante/CPTS initiative, Sote-area regionalization in Finland, and NABIDH and Malaffi in the UAE. German hospitals are starting implement IT funded from the €3.4B ($3.7B) Hospital Futures Act (KHZG) 2020. The awarding of KHZG contracts started to kick in during 2023 and the expectation is for contract award activity to peak through 2024.
Whilst in many instances the above initiatives are not HIE-specific, the digitisation across several of them is expected to drive substantial improvements to interoperability and information exchange across healthcare providers.
There is a high requirement for several IT systems to work together. This is largely due to several different EHR and “Best-of-Breed” hospital IT solutions in use. In England for example, each NHS Trust in has a Trust Integration Engine (TIE) that is used as a data warehouse to aggregate and normalize data from across an individual hospital Trust.
Cross-Border Data Sharing Initiatives
Examples of cross-border data sharing are gradually increasing. The European Health Data Space has a goal to improve interoperability and for EU residents to assume greater control over their electronic health data, with regulation approved by parliament in May 2024.
In Latin America, LACPass is a multi-country initiative that launched post-COVID with the initial aim of sharing vaccine information between participating countries.
Mayo Clinic has established a first-of-its-kind global alliance and data sharing network. As of April 2024, Mayo Clinic’s alliance included eight of the world’s leading health systems across three continents: Seoul National University Hospital (its most recent addition), SingHealth and UC Davis Health, which join Hospital Israelita Albert Einstein, Mayo Clinic, Mercy, Sheba Medical Center, Tel Hashomer and University Health Network as founding members. Mayo Clinic boasts four of the top 11 healthcare systems globally on its platform. It is striving to create the premier global health data network and platform disruption in healthcare, posing a longer-term threat to the competitive landscape of HIE/EHR vendors. With Mayo Clinic’s increasingly expanding global alliance and network, combined with its width (no. of records), depth (no. of data points per record) and spread of clinical data (diversity of records/data points), the initial signs are positive.
Data Analytics in the Context of PHM and Integrated Care
The effectiveness of PHM and Integrated Care initiatives is directly correlated with the quality and comprehensiveness of the data used. Healthcare data is typically stored in isolated systems, resulting in data silos. Obtaining a holistic view of the entire population is crucial to implementing effective predictive analytics and improved workflow and care management tools. This complete picture enables accurate predictive modelling, risk stratification, point-of-care clinical decision support, and targeted care pathways and care management interventions for optimal outcomes.
Legislation on Interoperability and Standardisation
After more than two decades of slow, steady progress in the market, developments have ramped up in the last year. This is particularly evident in the US; where HIE creation was historically driven by the Hitech Act which digitised and normalised EHR data, other factors are now adding wind to the market’s sails. From a regulatory perspective these include the 21st Century Cures Act promoting interoperability, and the HTI-1 information blocking penalty rule. Further, the establishment of a Trusted Exchange Framework and Common Agreement (TEFCA) and the creation of Qualified Health Information Networks (QHINs), of which there are now seven under the TEFCA umbrella.
In January 2024, the CMS finalised its Interoperability and Prior Authorization Final Rule requirements for payer-to-payer API-based information sharing, which should be in place by 2027. To date, +99% of data exchange has facilitated treatment purposes only, with minimal data electronically exchanged for non-treatment “purpose of use”, such as payment, research, etc. By 2027, the Prior Authorization ruling has the potential to drastically increase the amount of data flowing electronically and increase trust across the healthcare industry.
The US and Singapore are examples of countries imposing financial penalties of up to USD $1m to providers failing to comply with information sharing.
Market Barriers
Rising EHR Prevalence
In the US, hospitals relying on EHR vendors for inter-departmental solutions, and many of the biggest IDNs and health systems are consolidating around a single, large EHR vendor such as Epic, reducing demand for hospital-level HIEs. Governments in some geographies are driving the consolidation of EHRs at a regional level, where adopting the same EHR system regionally centralises data and reduces the need for extensive HIE infrastructure.
The use of best-of-breed solutions and enterprise-wide solutions varies not only by country, but also by hospital and further at a departmental level. Many of the administrative IT tasks are being transferred to an EHR solution, with best-of-breed solutions focusing on the advanced clinical aspects of the information systems. As integration continues to improve between solutions, there is still the flexibility of choice, however, cost often becomes the dominating factor in decision making; best-of-breed solutions tend to come at a higher cost.
EHR vendors hold a certain advantage as more hospitals are choosing enterprise-wide solutions. Many clinicians still prefer to use best-of-breed solutions, enabling them to utilize the most advanced department-specific tools. However, if an enterprise-wide EHR solution is installed it is more cost-effective to utilize a clinical module from the EHR vendor, especially when moving toward a ‘one record’ approach. Whilst medical professionals often prefer the advanced clinical functionality of a best-of-breed solution, there are often several stakeholders with conflicting views involved in the decision-making process. With several developed EHR geographies tending towards multi-million dollar investments in IDN/statewide EHR procurement, which often includes clinical modules, the justification for an additional investment in a best-of-breed solution is becoming difficult, irrespective of the cost.
Failure to Take Advantage of HIEs
There is a requirement for visual data analytics solutions that sit on top of the HIE to interrogate the HIE and present actionable insights (e.g. using Tableau, Microsoft Power BI). However, in healthcare settings where an HIE is in place, the data analytics element is far too often overlooked, inhibiting the benefit of having access to the aggregated data. In order to take full advantage of HIEs and analyse the aggregated data, this will often require additional spending on IT and analytics tools and a reorganisation of healthcare workflows, which may dampen demand for an HIE. Additionally, legislation across many regions (including Europe) has prevented the usage of analytics on patient medical data.
Outlook
Growth in the global HIE market is expected to remain uneven, with significant geographical disparity. However, all countries are striving towards HIE and interoperability in the long-term. The global HIE market is forecast to grow at a CAGR of 9% over the next five years, hitting $5bn by 2028, and representing a $2bn growth opportunity.
There are few greenfield opportunities for new state/province-wide deployments across the most advanced geographies, such as North America. The greatest potential for growth in developed markets is expected to be driven by demand for upgrading existing solutions, and implementing additional modules on existing solutions to support value-based care initiatives, such as health insights and care management tools.
Related Research
The above analysis is a summary of some of the trends assessed by Signify Research in its Health Information Exchange – World – 2024 market report. It provides a data-centric and global outlook of the HIE market by implementation type (i.e. National, State-wide, System-wide, Hospital-specific) and data architecture models (i.e. Centralised, De-centralised/Federated, Hybrid). The report blends primary data collected from in-depth interviews with healthcare professionals and technology vendors, to provide a balanced and objective view of the market.
About The Author
Arun joined Signify Research in 2019 as part of the Digital Health team focusing on EHR/EMR, integrated care technology, and high-acuity clinical information systems. He brings with him 10 years’ experience as a Senior Market Analyst.
About the Digital Health Team
Signify Research’s Digital Health team provides market intelligence and detailed insights on numerous digital health markets. Our areas of coverage include electronic medical records, telehealth & virtual care, remote patient monitoring, high-acuity clinical information systems, patient engagement IT, health information exchanges and integrated care & value-based care IT. Our reports provide a data-centric and global outlook of each market with granular country-level insights. Our research process blends primary data collected from in-depth interviews with healthcare professionals and technology vendors, to provide a balanced and objective view of the market.
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