Color me impressed: If today's issue is any indication, HIEs may have a brighter future than I'd previously thought. For one thing, this week we saw at least one powerful employer--the California Public Employees Retirement System--throw its weight behind a statewide HIE organization. In the same issue, you'll learn that about 75 percent of states have an HIE on the way.

After watching RHIOs/HIEs struggle for a couple of years, I'd gotten pretty pessimistic that they would be viable any time in the near future. Most privately-held ones seemed on the verge of financial collapse, while state projects looked like they'd be bogged down by bureaucracy for ages. But it appears that things have changed. States seem to have grown past their (justifiable) infatuation with e-prescribing and become willing to fund the longer-term HIE vision, as well.

This is quite an act of faith on their part. To back an HIE you've got to be willing to wait for the cost-savings from lower waste to mount up, and for evidence of quality improvements to trickle in gradually. And you've got to have an awful lot of capital available to you, both politically and financially, to get all of the stakeholders on board and connect them efficiently. 

Now, with states getting involved, I'm willing to wager that we'll see more private, commercial organizations making the kind of commitments necessary to keep RHIOs/HIEs afloat. But it's been a long, hard road getting here. Let's hope that everyone's faith is rewarded in the next year or two. - Anne [1]