Here is a story, granted from our backyard up in Boulder, that lays out some of the pricing and economic specifics around public HIEs.  The texture of the story has a little more depth to us because we know some of the players and some of the dynamics in that market.  While there are local market peculiarities in this story, there are some general issues that can be extended to a lot of markets.  Here are a couple:

• Federal grants to build a public HIE are one thing, but most likely, revenue to support on-going operating costs have to come from players in that market.  Until that problem is solved, the question of HIE sustainability remains open.
• $85 per provider a month, the price being asked by the Colorado RIO, is getting a lot of push back from physicians.  Bigger groups with leverage are pushing to negotiate side deals.  Smaller practices without clout are not jumping in.  Time will tell, but that dog (at that price) may not hunt.
• Related to that, when a primary care physician has to pay $1,020 per year to pay, but the largest system in the state (13 hospitals) pays only $300,000 for the year, expect many physicians to cry foul.
• Many of the docs in the community are already connected to their hospital and one another through the private HIE that is part of the common EHR system they all chose (and, surprise, this is one of the reasons they chose a common system).  Private HIEs, with a far more obvious value proposition to those involved in that particular delivery network, will continue to erode participation in public HIEs.
• The argument that docs should pay up because this is the right thing to do and will lower overall costs is either naive or down right patronizing.  The paying physicians do not participate in those savings, but they accrue to the payers (patients, employers, government, payers). Telling physicians that they should take a $1,020 a year pay cut for that motive is not a winning marketing strategy.