A new study reports that only 12% of the Health Information Exchanges studied are financially self-sustaining.

Funny how many organizations launched first, hired people, bought technology, printed cool brochures and are only now getting around to addressing the business model question.  We've launched a few organizations and seem to recall the business model, specifically the revenue model, being one of the very first things you have to nail down.

It is ironic that even before HIEs are out of the ground and running that the E in the acronym, exchange, is already a commodity that no one wants to pay for. 

Remember in the late 90s when the Internet was just a pup and we all were going to pay dearly for content?  Then here comes YouTube, Wikipedia, and 5 million bloggers. Revenue streams really do matter.

At the bottom of the linked story is the hidden gem.  More and more of the HIEs, and a disproportional share of those that are sustainable, are not shared public utilities, but privately held exchanges where the exchange of information is not an end to itself, but a key enabler of a larger strategic vision.

While it is fun to say, 'Well if you live in Chicago and are vacationing in LA and end up in the ER, we should be able to click and find your allergies and meds,' that is not a winning business model. 

This is not about passing bytes.  It is about enabling networks of providers of care to come together to deliver that in different ways. Delivery organizations that have such a vision have no trouble sustaining the exchange.  It makes the vision happen.  Absent that, no one wants to pay...for obvious reasons.

On a related note, dust off your mountain west gold mining history.  A lot of dreamers went bust in the hills looking for the nuggets, while the guys at the depot selling pick axes did just fine, thank you.  The vendors selling the HIE tools are also grinning.