The health information exchange (HIE) marketplace seems poised for a big upsurge in the next couple of years. That has positive implications for cloud-based medical information exchange – or at least it should. More on that below, but first let’s take a closer look at what’s happening with HIE’s.

The prediction on new growth in HIE’s comes from Black Book Rankings, a leading technology market and opinion research company. Based on a survey of 4,000 healthcare and insurance organization executives, Black Book found that 80% of hospitals and 97% of physicians have not yet implemented an HIE system. Eight of ten providers plan a significant increase in their HIE budgets by 2014, however.

The driving forces, says a statement by Black Book Partner Douglas Brown, are clearly “accountable care implementation, meaningful use implementations, the need for care coordination, outcome-based reimbursement challenges, available funding, and opportunities for regional stakeholder participation."

Of providers with an HIE strategy in place, 98% are focused exclusively on community or regional exchanges, not a national network.

It makes sense that HIE’s include cloud-based services like eMix in their strategizing. These services are the logical way for providers in an HIE to exchange large medical files such as high-resolution imaging files and associated patient information.

Specialty medical practices that expand to become large national providers gain some obvious efficiencies. Most importantly, they can aggregate the expertise and skills of elite physicians and make them available to patients from all over the country.

But if patients’ medical files can’t be easily transferred from their local providers to the national group, some of the advantages of going national go right out the window.

Such was the dilemma facing Pediatrix Medical Group, the nation’s leading provider of maternal-fetal, newborn and pediatric subspecialty physician services.

Pediatrix maintains a network of subspecialists and advanced practitioners that encompasses 34 states and Puerto Rico, so it accepts transfer patients from all over the U.S. But like other medical institutions, when it needed to receive transfer patient’s imaging files, it was forced to rely on traditional methods such as having the files burnt to CDs or DVDs and sent by ground or air.

That process was way too slow for emergency cases. It was also unreliable. Hard media can be lost, damaged, or misplaced. Even if a DVD does arrive in good shape, it may be unreadable.

Transfer on hard media was expensive, too -- $25-40 per mailing, which adds up in no time for an organization admitting the number of patients Pediatrix does. Finally, in some circumstances, courier service was not possible. For instance, one referring facility in the mountains of Colorado was sometimes snowbound, so no courier could get in or out.

When alternatives began appearing, Pediatrix reviewed them to find one that would fit its needs. It was seeking HIPAA compliance, security precautions such as encryption, and business protection in the event of an accidental breach of privacy/confidentiality.

Only one service all those criteria: eMix, which had the additional advantage of being able to transfer files at full diagnostic resolution. This feature impressed Pediatrix because it receives many files, such as echocardiograms, that are up to one gigabyte in size.

As of this writing, Pediatrix has implemented eMix at 11 of its 18 facilities, and has arranged to use it with 25 of its referring institutions. It also foresees using it for two applications related to its geographically disperse physician network:

• Real-time consultations that can involve multiple specialists in different areas, because all will be able to view the same files at the same time;
• Clinician education.

For Pediatrix, eMix has ended both technological and financial headaches, while also offering another way to expand its influence and reach.

So far, medical facilities, not patients, have been the primary end-users in the ongoing transition to cloud-based medical information exchange. But results from a new study show that, once patients are more fully included, they will be just as satisfied as medical professionals have been.

Patients in a beta project found cloud-based sharing "a faster, more efficient way to store and distribute their medical images than current options." Current options include CDs, still the most common way to share radiology files despite a host of drawbacks and limitations previously discussed in this space.

The patients are taking part in Image Share, a project of the  Radiological Society of North America (RSNA). The society describes Image Share as "a network created to enable radiologists to share medical images with patients using personal health record (PHR) accounts."

Image Share is administered by RSNA and includes about 600 patients from five sites: The Mount Sinai Medical Center (Miami Beach, Fla.); University of California - San Francisco; University of Chicago Medical Center; Mayo Clinic; and the University of Maryland Medical Center (Baltimore, Md.).

The project works very much like eMix. Once patients create an account and password, they are allowed access into the system. It enables them to import their images and reports into their PHR. The transfer is secure because the information is encrypted when it is sent and remains that way until it arrives in the patient’s account.

David Mendelson, MD, FACR, is Chief of Clinical Informatics at The Mount Sinai Medical Center and Chief Clinical Investigator for RSNA Image Share. He has stated that cloud-based medical information exchange is "the next revolution in digital imaging." He describes numerous advantages of the approach including giving patients ownership over their records and making radiology information more accessible to physicians.

Plus, he says "it decreases unnecessary radiation exposure that can be caused by physicians’ ordering duplicate examinations due to records not being easily available."

We couldn’t have said it better ourselves.

We’ve been told for awhile that there’s a big change coming in how healthcare is delivered and paid for.

Update: The transformation is here, and it places a premium on efficient sharing of healthcare information.

That’s the word from Paul Grundy, M.D., MPH, a presenter at the 2012 CHIME/HIMSS CIO Forum in February. Grundy, who is president of the Patient-Centered Primary Care Collaborative and director of healthcare transformation at IBM, pointed to the growing percentage of healthcare that is now delivered via the patient-centered medical home (PCMH) model – and also the growing share of payments from private and government payers now going to PCMHs.

A PCMH is a team of providers led by a personal physician who coordinates the patient’s care with various sub-specialists. As Grundy noted, no one provider in a PCMH completely owns patients or their data, so data has to be shared with all relevant team members – smoothly, quickly, and reliably.

Cloud-based medical information exchange has a role to play in this process. Where imaging files are concerned, no method better fits the PCMH scenario than a cloud-based service like eMix that almost instantly move medical files and reports to any provider’s Web-connected computer, including tablets and smart phones.

Moreover, today's Facebooking, tweeting patients expect new types of interactions with their providers, including virtual interactions.

As one sign that medical manufacturers have already geared up for this new reality, consider VGo, a new, remote-controlled “telepresence” robot that, among other uses, enables providers to see and interact with patients as if they were in the same room.

To understand the growing potential of patient-centered medical homes, just follow the money.

Two large private payers, WellPoint and UnitedHealthCare, are redoing their reimbursement and delivery approaches. On the government side, the Centers for Medicare & Medicaid Services (CMS) has committed 11 percent of payments to approaches other than fee-for-service. This redirection of payments will drive more and more providers to adopt the PCMH model, Grundy said.

Why the sudden shift? It’s in part because payers are fed up with the inefficiencies of a healthcare system too heavily reliant on unregulated fee-for-service and rescue/specialty care, Grundy said.

The goal of the PCMH is to improve outcomes and reduce costs through coordinated care. Grundy described several studies showing that the PCMHs studied were already resulting in fewer hospital readmissions and shorter hospital stays.

What does it all mean? A new model of healthcare and provider compensation is here to stay. At the same time, robots at patients’ bedsides and imaging files shared via the cloud are carving a place for themselves in contemporary healthcare. The convergence of these new arrivals could be beneficial for all parties.