Massachusetts Medical Society: A ''Tipping Point'' for Health Information Exchanges?

A ''Tipping Point'' for Health Information Exchanges?


Health Information Exchanges (HIEs) are software systems put into place to allow physicians using different EMRs or operating in different networks to communicate with one another and securely share patient information.

But the technology currently doesn’t have enough participating doctors to achieve a “tipping point” and let it live up to its full potential.

The Mass HIway, the Massachusetts’ state-run HIE built several years ago with matching federal and state funds, allows users to send HIPAA-compliant messages and patient information through a secure online messaging service called DIRECT Messaging. DIRECT Messaging is also used by several private HIEs that have partnered with the HIway to connect as many providers as possible. Independent exchanges include Wellport in Newburyport and eLINC, created to service Winchester Hospital and its surrounding communities. Both of these work with anyone connected to the HIway.

Both eLINC and Wellport have added additional clinical functions to their messaging systems. eLINC connects a community of doctors across 76 practices, provides services that include: DIRECT Messaging, instant delivery of lab and radiology results, as well as discharge and other reports from various hospital departments; improved communication among physicians; and, Emergency Department notifications to reduce patient re-admission and more effectively manage patient care. It will be possible to connect with over two dozen EMRs systems for secure messaging. The collaboration between eLINC and the state also resulted in improvements to the DIRECT Messaging system. “The state has done an excellent job; they’re very competent, and we partnered with them to expand their original vision of how DIRECT worked. We were happy to work with the state and they were willing to let us push the envelope,” said Jay Caturia, Winchester Highland’s senior EHR project analyst.

eLINC has also pioneered a repository system that, according to Winchester Highland’s Electronic Health Record (EHR) Director Eddy Rospide, allows users to create a “longitudinal view of the same case over time — basically a whole record that is made up of contributions from different providers, using different EMRs, to create a consolidated patient record.” eLINC also provides integration services like EMR vendor engagement, HIPAA training, and patient authorization training.

HIway Partners

The other HIway partner is the Wellport Health Information Exchange. It was created by a medical community in the Merrimack Valley, a community that was an early pioneer in developing a community-based HIE. Although it is not as widespread as eLINC, the system was built by and for doctors, and their HIE also has a timeline system, shows full medical history/progress notes for the last three years, and is able to flag any issues that may have gone untreated too long or have worsened over time. Wellport can also use the DIRECT messaging system from HIway to email any particular part of the patient record to another doctor. Dr. Joe Heyman (former president of the MMS and current CMO of Whittier IPA, the company behind the Wellport HIE) would like to expand their system beyond the Merrimack Valley. “Our vision here is to make the HIE available to anyone who wants to subscribe, and give them access to full and robust clinical information,” he said. Despite Massachusetts’s relatively high and growing EHR penetration rate, more doctors and more patients need to be part of a HIE, whether it is private or the HIway. Dr. Joe Heyman says the current state of things is “like a chicken-and-egg thing — if the patients aren’t in, the docs won’t use it; and if the physicians aren’t in it, it’s harder to convince the patients to do it.” Dr. Heyman commented that despite its usefulness, the HIway is “not a very well-used system — some physicians aren’t even aware they have DIRECT addresses, especially in larger networks.”

Slow Adoption

Massachusetts’ status as a health information opt-in state is also a factor in the slow adoption rate, as patients need to fill out a consent form in order to have their information made available on a multi-network HIE.

Dr. Heyman said that for the Wellport HIE, their consent form can be a barrier. “I think it can be greatly improved, for example, to have the patients opt-in directly online,” he added. “Consent can be an issue, but there is good guidance available to clarify what DIRECT Messaging entails for doctors and patients,” according to Laurance Stuntz, the director of the Massachusetts eHealth Institute.

HIE Functionality Increasing

Despite the issues with early adoption, however, HIEs are only going to become more prevalent. The HIway has connected with major health systems and EMRs like Beth Israel, Partners Healthcare, and athenahealth, while eLINC is interfacing with MediTech, athenahealth, and Practice Partners. Many EHR vendors have only recently enabled full connectivity with HIEs, but now built-in connections and enhanced HIE-EMR functionality are becoming more common.

The cost of getting involved with an HIE varies depending on the complexity of the system, the size of the network, and several other factors; the eHealth Institute has compiled a price sheet for the cost of getting plugged into the HIway. The cost scales with the size of the practice or health network involved; a “Tier 1” provider, like a large hospital or commercial lab, will pay around $120,000 for full hardware integration into the HIway, while a “Tier 5” network (small practices of only one or two doctors) will only pay about $400. Anyone can sign up for a DIRECT webmail address for $5, regardless of his or her practice size.

What is the future of HIEs? That will vary from system to system, but Rospide and Caturia firmly believe that complete interoperability is both the “next big hurdle and next generation” of HIE technology. They envision a future where information can be easily and safely shared across all HIE systems throughout the state. Stuntz believes that the HIway will continue to expand; while it will never be as specialized as a private HIE, it will “focus on the highest-value systems that can be broadly applicable across many different geographies and providers.”


For more information about the HIEs discussed here, visit

Share on Facebook

New: Advertise With MMS

Increase your brand awareness and visibility to physicians and the general public through advertising space on the MMS website and several MMS email newsletters.

Read More »

Subscribe to e-Newsletters

Stay on the cutting edge of medicine by subscribing to free MMS e-newsletters. Choose from up to ten subject areas including physician and patient advocacy, public health, CME, daily health care news, and more. 

Sign Up »

NEJM Resident 360  Ad

Copyright © 2018. Massachusetts Medical Society, 860 Winter Street, Waltham Woods Corporate Center, Waltham, MA 02451-1411

(781) 893-4610 | (781) 893-3800 | Member Information Hotline: (800) 322-2303 x7311