When the Indiana Health Information Exchange launched in 2004, it was one of nine truly operational exchanges around the country. Today, the Indianapolis-based organization is one of 73, according to the latest national survey by the eHealth Initiative.

That’s a sign of the attention paid to exchanging medical information electronically. But the folks behind the survey say the nation is a long way from the exchanges being commonplace.

One reason is that only 18 of those operational exchanges are breaking even financially. More than one-third say they depend on federal funds, such as stimulus money that poured into the field but will not be ongoing.

“Notwithstanding the recent infusion of federal funds, sustainability continues to be an issue for the initiatives,” noted the eHealth Initiative report accompanying its survey results. The not-for-profit group is based in Washington, D.C.

The Indiana Health Information Exchange is one of four operational exchanges in Indiana. It has a relationship with 62 hospitals and more than 14,000 physicians, some of which are in Illinois.

Health information exchanges need to sign up more doctors and hospitals to use their services, and to document that the exchange does indeed help them save money, according to eHealth Initiative officials.

In this year’s surveys, 30 or more exchanges said their users’ staffs spent less time on filing records and handling lab results. Also, 28 exchanges said their customers were saving money by avoiding redundant tests.

But far fewer could report the kind of changes everyone hopes health information exchange can help accomplish: only 16 exchanges reported fewer medication errors and decreased costs for patients with chronic diseases.

All those totals were up significantly from the previous year’s survey.

“There is definite progress here, but that doesn’t mean we can rest on our laurels,” eHealth Initiative CEO Jennifer Covich Bordenick said in a statement. “More initiatives and providers need to document cost savings.”