It’s clear health information exchange is a prized goal within the U.S. and the market for HIEs is growing around the world; according to a MarketsandMarkets report released in 2014, the global HIE market was valued at $558 million in 2013 and is projected to be worth $878 million by 2018, rising at a compound annual growth rate (CAGR) of 9.5%.
While North America accounted for the largest share of the global market in 2013, the Asian region is expected to grow at a higher CAGR, the report stated.
At the same time, travel is on the rise. Earlier this year, the World Travel and Tourism Council announced that long-term forecasts for travel and tourism show continued annual growth at 3.8% over the next ten years, which is higher than the global economy and most other major industries. In addition, just last month, a report from Market Research Store projected the global medical tourism market is expected to grow at a CAGR of 19.38% through 2019.
This all begs the question of whether international HIE is underway, to allow appropriate care as patients access providers across borders.
According to Dr. David Kibbe, president and CEO of DirectTrust: It should be, and it could be. But it isn’t yet. While the technology is available, he says, the issue comes down to policy and initiative.
DirectTrust has been looking at the subject as a nonprofit healthcare industry alliance that provides interoperable HIE via a protocol known as Direct, which now has 40,000 U.S. healthcare organizations involved.
Kibbe describes Direct as the most common form of secure HIE in the U.S., and says it’s a solution that could easily be utilized internationally because it’s open and based on international protocols, specifications and standards. It involves point-to-point communication over the Internet that is secure, encrypted and identity validated.
The problem, so far as he has seen, is there has been no call for international HIE. “I think exchanges of information are occurring, but I don’t think anybody’s put much thought into doing it in an internationally secure way," he says. “I think a lot of the international HIE that is currently done now is done in the clear—it’s done in a non-encryped, insecure manner—and I wonder why that is.”
In addition to regular travel and medical tourism, Kibbe points toward international crises as situations where HIE could be valuable.
“We’re still hopeful that we’re going to get a call one of these days from the UN about the exchange of information going on in the United States and whether we could help do that internationally," Kibbe says. "My answer would be 'Yeah, we’d be glad to do that.'”
International policy appears to be in early and complicated stages. On the one hand, the US and the EU have agreed on a roadmap to support international interoperability of electronic health information and communication technology. On the other hand, the European Court of Justice this week struck down the Safe Harbor Framework that allows companies to transfer data from Europe to the United States, based on concerns that European data are not protected in the United States.
While many companies are likely to continue the data flow, there may now be new issues of compliance and regulation under European law. For now, the U.S. may have enough to chew within its own borders.