Health Information Exchange Assignment Paper

Health Information Exchange Assignment Paper

Health information exchange is the standard electronic movement of health-related data amongst organizations. The main objective is to provide access of clinical data to the respective organizations to ensure an effective, timelier, secure, and patient-oriented health care. The Health Information exchange organizations (HIOs) are the ones that offer the services of health information exchange. Most of these HIOs are presently operating under the regional hence they are regional health information organizations (RHIOs).Health Information Exchange Assignment Paper

Health information exchange is organized through an established governing structure, optional input and output models, and selection of a vendor. In terms of governing structure of the health information exchange, for the facilities that are operating in the same regional market patient information is shared through a consensus. A board of directors for Health information exchange consists of equal representation from all the organizations

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Electronic health information exchange (HIE) is improving the quality and efficiency of healthcare by allowing healthcare providers to access and share patient medical information via computer.

A Health Information Exchange (HIE) is a technology solution that enables Healthcare providers and organizations to share patient information electronically between systems that would otherwise not be connected. If you as a patient receive care in a different city, state, or even country; a connected provider could use an Electronic Health Record (EHR) system to retrieve your vital medical history from an HIE. That data resides natively in another system. You can think of the HIE as a data clearinghouse among many clinical participants. Every system that sends or receives data on an HIE follows a data standard to ensure correct formatting.Health Information Exchange Assignment Paper

The adoption of HIEs has gotten a boost by the Federal Office of the National Coordinator for Health IT (ONC). The department was established via Executive Order in 2004, and has been very active in Healthcare IT policy since. Also, Congress has allocated $548 million to the states to help fund the implementation of HIEs for the States.

HIEs address many problems that have existed in the delivery and coordination of care. For example, when patients have care among several providers who do not share information, this creates fragmented care. That fragmentation can lead to duplicate orders and testing, medication errors, and possible errors in diagnosing medical problems.

Many practices have used faxing for years to communicate patient information, and while this is better than nothing, it has inherent disadvantages:

You usually need to be at the fax machine to receive records
Even if you use e-faxing, the data is still in document format, meaning the data cannot be extracted and analyzed
Mechanical failures can trash the documents, as we’ve all experienced

So it’s easy to see why HIEs can make coordination of Healthcare much easier and efficient. Let’s have a look at the different types of HIEs.Health Information Exchange Assignment Paper

Types Of Health Information Exchanges

Directed Exchange

This is probably the most common form of HIE. In this setup, there will be providers from many different types and sizes of medical practices, also using different EMR vendors. Exchange data is sent over an encrypted secure connection. Here is a scenario of how this kind of HIE transaction would occur:

You visit your Primary Care Physician (PCP) to be seen for some allergies that have been difficult to diagnose. The PCP is on an EMR that is connected to a State operated HIE. The PCP will refer you to an Allergy Specialist who is on a different EMR that is also connected to your State’s HIE.

The data that needs to be communicated is your list of known allergies, medical conditions, labs, and insurance information. The data would be pushed to the HIE by the sending Provider during or after your initial visit.

Another example of a Directed Exchange that has been around for a while is Immunization Registries. While some may call them Registries and not HIEs due to being a single set of data; I don’t think that really matters. Most that I’ve researched are seen as both Registries and HIEs.Health Information Exchange Assignment Paper

Query-based Exchange

Where the Directed Exchange is more of a “push” transaction, a query-based transaction is a “pull”. In the above example, the Allergy Specialist would initiate a transaction that queries the patient’s PCP for all of the relevant clinical data.

The query-based transaction is also extremely helpful in cases of unplanned care. If a patient lands in the ER away from their hometown, the facility can query an HIE to gather the information needed to provide the best possible care.

Consumer Mediated Exchange

In a Consumer Mediated Exchange, patients are involved in the collection and transmission of Healthcare data to Providers. They may use a cross-platform solution such as Microsoft HealthVault to input data, including the collection of data from fitness devices and Apps. They may then document any medications or conditions that have been missed during office visits. HealthVault would transmit that information to a State HIE. From there, the information is added to the rest of their medical record when downloaded by a care Provider.

Health Information Exchange Vendors

HIEs can be components of existing Electronic Health Records (EHR) systems, or developed as standalone applications. The two largest EHR vendors – Cerner and Epic each have their own HIE components built into their architecture. Those systems are mainly intended to share records between many providers of those native systems, but also have the ability to share data ‘on the open market’ to competing EHRs.

Vendors who develop their own standalone solutions include Covisint, Informatics Corporation of America, and Infor. In 2015, there was a lot of news concerning EHR vendors’ participation, or lack thereof in HIEs. Many of the large electronic health records vendors, such as Cerner and athenahealth participated in the CommonWell Health Alliance, with Epic resisting calls to participate. This caused many industry analysts to criticize Epic, charging them as being opposed to sharing health data. However, in early 2016, Epic did get on board with the Carequality Interoperability Framework.Health Information Exchange Assignment Paper

Do Health Information Exchanges Work?

As with a lot of technology in Healthcare, some things are hard to measure. HIEs will very likely result in an increased satisfaction by patients as their care becomes more integrated. A study published by Perspectives in Health Information Management indicated that only 50% of HIE executive are even planning on using metrics to measure success. However, from the executives they were able to survey, 56% reported positive return on investment, and 44% felt that more evidence was needed to determine success.

Electronic health information exchange (HIE) is improving the quality and efficiency of healthcare by allowing healthcare providers to access and share patient medical information via computer.

HIE isn’t a substitute for direct communication between provider and patient. However, it helps ensure patient’s records are complete because past medical history and test results are reviewed each time a patient re-visits a health provider.

Using HIE to share important patient information helps both patients and physicians make healthcare decisions. The shared information helps prevent mistakes such as medication errors, wrong diagnoses and duplicate testing.

The real value of HIE comes from data standardization practices. Uniform data can be integrated into the user’s electronic health record (EHR), a process which makes a more personalized body of health information. For example, if lab findings are received and added to a provider’s EHR, a list of patients with diabetes can be made. The provider can then determine which patients need immediate care due to symptoms such as consistently high blood sugar. This creates a ranking of urgency for scheduling follow-ups with those patients.Health Information Exchange Assignment Paper

Currently, there are three main forms of HIE:

Directed Exchange: Sending and receiving protected information between different healthcare providers for patient support
Query-based Exchange: The ability to allow healthcare providers to search and request information regarding a patient from different healthcare providers
Consumer Mediated Exchange: Allowing patients to collect and maintain control of their personal health information.

HIE organizes patient care, reducing the occurrence of duplicate treatments since everything is more clearly documented. Some other benefits include:

Giving healthcare providers a way to improve the quality and safety of patient care as fewer and fewer mistakes are made.
Creating a feedback loop between health-related research and health practice, making things clearer for patients and providers alike.

Electronic health information systems help reduce the number of errors by keeping everyone involved in a patient’s care. The key is that everyone has access to the same health information, so they can collaborate and do what’s best for the patient. HIE streamlines healthcare by enabling automatic appointment reminders or follow-up instructions to be sent directly to patients, and the prescriptions they need get sent directly to pharmacies. HIE focuses on spending less time sifting through paperwork and more time allowing patients to have discussions with their healthcare providers about their health and the treatments they need.

Currently, there are three main forms of HIE:

Directed Exchange: Sending and receiving protected information between different healthcare providers for patient support
Query-based Exchange: The ability to allow healthcare providers to search and request information regarding a patient from different healthcare providers
Consumer Mediated Exchange: Allowing patients to collect and maintain control of their personal health information.

HIE organizes patient care, reducing the occurrence of duplicate treatments since everything is more clearly documented. Some other benefits include:

Giving healthcare providers a way to improve the quality and safety of patient care as fewer and fewer mistakes are made.
Creating a feedback loop between health-related research and health practice, making things clearer for patients and providers alike.

Health Information Exchange and RHIOs

When individuals receive care from multiple providers, there is an intrinsic need for providers to share information. Many networks do not have a system in place to share electronic medical records or general client information, so alternatives may be necessary. One option is arranging a Health Information Exchange (HIE), which is an interface for care and support providers to share critical, confidential medical information. A Regional Health Information Organization (RHIO) is the most common medium for supporting a Health Information Exchange.

RHIOs gather a variety of stakeholders to reach consensus on the specific information that is allowed to be shared among participating entities. All participating entities are required to sign data use agreements prior to any information being shared. This may involve presenting the agreed upon parameters to the compliance officer to gain organization-level approval. Participating entities are required to have adequate capacity to efficiently store and manage electronic data. As a practical consequence, RHIOs often provide health information technology (HIT) assistance to providers at the institutional level.Health Information Exchange Assignment Paper

State Health Information Exchange Cooperative Agreement Program

In March 2010, ONC completed the announcement of State Health Information (State HIE) Exchange Cooperative Agreement Program awardees. In total, 56 states, eligible territories, and qualified State Designated Entities (SDE) received awards.

The State HIE Cooperative Agreement Program funds states’ efforts to rapidly build capacity for exchanging health information across the health care system both within and across states. Awardees are responsible for increasing connectivity and enabling patient-centric information flow to improve the quality and efficiency of care. Key to this is the continual evolution and advancement of necessary governance, policies, technical services, business operations, and financing mechanisms for HIE over each state, territory, and SDE’s four-year performance period. This program is building on existing efforts to advance regional and state-level health information exchange while moving toward nationwide interoperability.

On January 27, 2011, an additional $16 million was made available to states through ONC’s new Challenge Grants program. This program will provide funding to states to encourage breakthrough innovations for health information exchange that can be leveraged widely to support nationwide health information exchange and interoperability. The HIE Challenge Grant Program is providing 10 awards between $1 and $2 million to State HIE Cooperative Agreement Program grantees to develop innovative and scalable solutions in five key areas, including:

Create and implement up-to-date privacy and security requirements for HIE
Coordinate with Medicaid and state public health programs to establish an integrated approach
Monitor and track meaningful use HIE capabilities in their state
Set strategy to meet gaps in HIE capabilities
Ensure consistency with national standards

A Regional Health Information Organization (RHIO) is a group of organizations within a specific area that share healthcare-related information electronically according to accepted healthcare information technology (HIT) standards. A RHIO typically oversees the means of information exchange among various provider settings, payers and government agencies.Health Information Exchange Assignment Paper

The RHIO is one model toward achieving the proposed National Health Information Network (NHIN) in the United States. The key components of the health IT infrastructure are:

Electronic medical records (EMR) and electronic health records (EHR) for healthcare professionals.
Personal health records (PHR) for individuals.
Health information exchange (HIE) to facilitate electronic communications among all entities involved.
The Regional Health Information Organization (RHIO), which organizes and oversees facilities participating in information exchange within a geographical area.

Importance of the role of Regional Health Information Organization

A Regional Health Information Organization brings together various stakeholders in geographic areas, such as healthcare providers, hospitals, smaller clinics, payers and government agencies, to safely and securely share health-related information electronically for the purpose of improving health and care.

Exchanging clinical information electronically enables doctors, nurses, pharmacists, other healthcare providers and patients to improve the speed, quality, safety, coordination and cost of patient care.

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RHIOs also support the use of clinical data for research and to assess and improve the quality of care that hospitals and healthcare providers provide.

RHIOs also improve the quality of healthcare and patient outcomes by:

Decreasing medical and medication errors.
Reducing unnecessary tests and services.
Ensuring everyone involved in the care of a patient has access to the same information.
Decreasing administrative costs by simplifying many administrative tasks.
Increasing patients’ involvement in their own healthcare.
Reducing the time patients spend filling out paperwork.
Decreasing the time patients spend briefing providers about their medical histories.
Coordinating with as well as supporting public health officials to improve the health of people in their communities.Health Information Exchange Assignment Paper

Key components of RHIOs

Although no two Regional Health Information Organizations are exactly the same, they typically consist of similar organizational and technical components that allow them to electronically share patient information with their stakeholders.

Organizational components include:

Documented standards for data-exchange – all stakeholders agree that they will support the agreed-upon formats for the exchange of personal health information (PHI).
Participation agreement – a formalized relationship between the RHIO and the stakeholders that includes legal obligations and payment terms.
Data-use agreement – stakeholders agree on how to use the data that they receive via the RHIO, such as limiting the use to treatment purposes.

Technical components may include:

Implemented data interfaces – the way the RHIOs send and receives patient data may include user-interface features that are integrated within the existing electronic health records (EHR) systems of the stakeholders.
Master patient index – consolidates patient demographic information and unique identifiers across the participating organizations to match patients’ clinical information that’s held by different providers.
Record-locator service – tracks the presence and location of patients’ data among the stakeholders.
Patient-data repository – some RHIOs aggregate, normalize and store patient data that’s submitted by the participating organizations.
Data-sharing applications – these provide various functions, including document retrieval, search, alerts and data analysis, for the patient data that’s accessible via the RHIO.

Examples of RHIOs

One example of a RHIO is the Orange County Partnership Regional Health Information Organization (OCPRHIO), California’s community-wide health information exchange initiative. OCPRHIO is working collaboratively to connect providers across California electronically so they can easily access patient records whenever and wherever they need them. OCPRHIO’s mission is to support a unified approach to secure health information exchange among healthcare stakeholders, including patients, in California.

The Bronx Regional Health Information Organization (Bronx RHIO) in New York City is a clinical information exchange established by the borough’s leading healthcare organizations, including hospitals, health systems, ambulatory care centers, individual physician offices, long-term care, home care as well as community and other organizations.

The Bronx RHIO offers a secure, interoperable health information exchange that enables providers across the borough to access vital patient information from multiple sources where and when they need it to deliver better, safer and more efficient healthcare. The organization’s mission is to build a secure, interoperable health information exchange that will make it possible for patients’ medical records to follow them wherever they go for health services in the Bronx.

The Colorado Regional Health Information Organization (CORHIO) is committed to advancing healthcare by improving information technology and data exchange between people, providers and communities by giving them the information they need to improve health. CORHIO’s health information exchange technology, data analytics tools and expert consulting help healthcare providers access information that streamlines the coordination of care, reduces costs, improves clinical outcomes for millions of people and saves lives.Health Information Exchange Assignment Paper

The evolving healthcare environment is requiring changes in the delivery of healthcare services and sharing of health information that can enhance the patient’s experience and access, improve health outcomes, and reduce costs (“The Triple Aim”). As Telemedicine can provide improved access to healthcare services that support distant providers, and patients, including the pediatric population and their families, a Health Information Exchange (HIE) provides a system for the secure sharing of patient information from a variety of healthcare provider organizations and their diverse electronic health records (EHRs) that otherwise cannot easily share patient information and thus can create one consolidated integrated record. The HIE in New Mexico, called the New Mexico Health Information Collaborative(NMHIC), has been designed to allow a patient’s health information to be consolidated into a single view and record from a variety of EHRs, listing the original source and time of all diagnoses, medications, allergies, immunizations, procedures, lab and radiology reports, and even progress notes and summaries. Using established standards, such as through HL7 and other formats for interoperability, and creating an interface with each organization’s electronic health record, there can be secure bi-directional sharing of protected health information among all authorized participants in the HIE. The integration of HIE with Telemedicine is particularly critical since telemedicine encounters often involve healthcare provider organizations on different EHRs and thus a consolidated record is critical to improve the efficiency, continuity and coordination of appropriate comprehensive care. There are increasing examples of successful HIEs but challenges remain related to sustainability and establishment of good business planning models. As is being implemented in New Mexico, a large rural state, criteria for adoption are being developed to address the value proposition and demonstrate a return on investment through the perspective of various stakeholders, including healthcare provider organizations, their providers, their patients and families, EHR vendors, and insurers.

There is no doubt that a visit to a clinical setting is intimidating: fear of the unknown, not sure what to expect, and other factors. But what if your physician is connected to a health information exchange? As a patient, you will benefit from access to information across a care setting, lower healthcare cost due to elimination of redundant tests and procedures, and an increase in the quality of care provided since longitudinal information may exist.Opportunities and challenges of electronic health information exchange

A 5-day-old was seen in clinic for her newborn visit. She had been born at another health care system that was not affiliated with the clinic.

In the old days, the clinic visit would have been complicated by the frustrating and time-consuming process of obtaining written consent from the parent/guardian to view the infant’s medical records, faxing the record request form to the other health care system and waiting for a return fax. Alternatively, the doctor could assume “nothing of continued consequence had happened during the birth admission” or could ask the mother if “anything significant had happened during the birth admission.”

Fortunately, the two health care systems were connected through a health information exchange. Hence, it was a relatively seamless process to obtain access to the entire record from the health system where the child was born, including labs, provider notes, vital sign readings and weight measurements, and to pull that information into the electronic health record (EHR) where the patient was currently being seen.

This example describes the best-case scenario for electronic health information exchange. When it works, electronic health information exchange has been shown to reduce unnecessary and duplicate testing, imaging and admissions, and increase provider efficiency.Health Information Exchange Assignment Paper

Tens of millions of patient documents are exchanged monthly throughout the United States, both within EHRs of the same vendor and between EHRs of different vendors. However, several challenges remain.

One of the major challenges, especially in pediatrics, is the lack of a universal identifier. In the example above, the two systems were not automatically able to identify the patient because she was registered under a different name in each system — one that was tied to the mother’s name in the hospital system where the child was born and the other that was the child’s full legal name in the second health care system. In this case, a brief phone call was needed to match the patient in both systems.

Secondly, electronic health information exchanged often contains only a summary document, which may be referred to as a Continuity of Care Document, Continuity of Care Record or Consolidated Clinical Document Architecture. Because these are generic summary documents, they sometimes leave out pieces of information that may be important for a specific patient or, conversely, may include too much information, making it hard to find the pertinent information. Sometimes having the “raw” information is more helpful than having the summary.

Another challenge with electronic health information exchange is discrete information integration and reconciliation. Conceptually, we want to know all the medications a patient was prescribed, all the immunizations received and all of his allergies and problems. Electronic health information exchange can present all of this outside information, but it needs to be integrated and reconciled. The integration and reconciliation process sometimes can take a significant portion of the visit, and duplicate information may not be easy to eliminate. Also, many pharmacy benefit plans provide prescription fill information through electronic health information exchange, which can be helpful in some clinic situations. However, this additional piece of information must be integrated into clinic visits that already are too short.

The example described illustrates “pull” electronic health information exchange in which a pediatrician or health care system manually or automatically searches for patient information in other systems.

“Push” electronic health information exchange, also called direct messaging, is evolving. This is a type of secure, Health Insurance Portability and Accountability Act-compliant email that can be embedded in an EHR, whereby a pediatrician or health care system can “push” or send a message to another pediatrician or health system. For example, a message can be sent to notify a pediatrician that his or her patient has been admitted to another health care system, or a specialist can send a message notifying the primary care pediatrician in another health care system of consultation results.Health Information Exchange Assignment Paper

Hopefully, every point of care for children in the United States (and internationally) one day will have seamless electronic health information exchange that will allow all health care professionals to provide higher-quality and more efficient and cost-effective patient-centered care.

One example of this is a case of viewing the growth chart for an older boy who recently was seen in clinic. The patient was identified automatically through the vendor-based health information exchange as having data in another health care system. Weight and height measurements from the other health care system were automatically imported and integrated into the clinic’s EHR to generate a single growth chart using different colors to represent the internal (dark blue) and external (light blue) growth measurements (see figure below). All that was required was to follow a normal workflow of reviewing growth charts at well-care visits, and all of the information from the multiple health care systems was automatically presented.

A 5-day-old was seen in clinic for her newborn visit. She had been born at another health care system that was not affiliated with the clinic.

Four health information organizations recently convened to discuss their challenges and successes in interoperability stability and infrastructure.

A health information organization is government-led, nonprofit group that creates interoperability and EHR exchanges on a state, regional and national level. They usually are helmed by a board of leaders from different sectors of healthcare.

These organizations were awarded $2.5 million in 2016 from the Office of the National Coordinator for Health Information Technology (ONC) to advance admission, discharge, and transfer (ADT) notifications to providers, facilities, and care managers within their states and to neighboring states.

Here are four of the biggest challenges they encountered, based on findings released in an ONC whitepaper:

1. Rules restricting information sharing

The Delaware Health Information Network is an HIO that aimed to grow its ADT notifications with providers, hospitals, and consumers within Delaware. It ran into challenges communicating with other health information organizations that had more restrictive agreements limiting the type of data being shared and the types of providers, hospitals, and patients allowed to receive the data.

For example, one HIO required patients and providers to have had a face-to-face encounter in the last 18 months in order for the patient’s data to be sent to the provider. In response to this issue, DHIN built new technology to proactively ask providers in Delaware their National Provider Identifier numbers to verify patient-provider relationships.Health Information Exchange Assignment Paper

2. Behavioral health disconnects

Reliance eHealth Collaborative, an HIO, and the Oregon Health Authority had three goals

Expand ADT notifications with high-risk patients in Oregon;
Collaborate with the Emergency Department Information Exchange and PreManage to connect with hospitals in Oregon, Washington, and California; and
Allow providers in Washington and Northern California access to Oregon Health Authority’s statewide Flat-File Directory.
The collaborative reported difficulties creating robust alerts that reported on clinical concepts and not just a single health event. The organization also faced barriers connecting with behavioral health EHRs. “Reliance reported that it might have been able to alleviate some of the challenges of working with behavioral health EHRs had it started working with these vendors earlier in the program,” according to the ONC report.

Nations around the world provide various medical information services. Among them, online health information exchange (HIE) services have been expanded internationally among hospitals and communities. Previous studies related to HIE have shown that adoption of HIE services leads to higher patient satisfaction due to stronger therapeutic intervention and improvements in patient outcomes [1,2,3,4]. Furthermore, if patient clinical information is shared in a timely manner, the accuracy of diagnosis is improved, test duplication is reduced, and patient re-admission and medication errors can be prevented [5,6]. The purpose of HIE is to improve the quality of patient care through timely sharing of health information. Recently, health information services have been expanding into HIE environments between communities or countries beyond the exchange of health information in hospitals using advanced information processing technology and high-speed network infrastructure [7].

In the United States, medical information exchange systems have been implemented through the focus on medical information technology in the American Recovery and Reinvestment Act enacted in 2009. This act establishes the roles and functions of the Office of the National Coordinator (ONC) for Health Information Technology and encourages the development of a medical information technology infrastructure that can be shared throughout the United States. The United States has carried out a variety of projects to develop online HIE systems at the national level, and every state in the United States decides on and improves policies at the state level while executing state-level projects. For online HIE methods, direct and query-based exchanges can be used, and most states employ both types of exchanges simultaneously [8]. France established the Agence des Systémes d’Information Partagés de Santé (L’ASIP Santè) to define a framework for the improvement of medical information sharing. The implementation of HIE profiles in France required additional setup to meet the requirements and the medical environment. They arranged profile vocabularies using the Classification Commune des Actes Médicaux (CCAM) and ICD-10, they used the HL7 Clinical Document Architecture (CDA) for clinical document standards, and they used Logical Observation Identifiers Names and Codes (LOINC) and SNOMED for examination term standards [9,10]. The basic act for personal information protection in France is the Act on Data Processing, Files, and Individual Liberties, enacted in 1978. The enforcement ordinance of the act specifies detailed regulations for medical research requests for personal data [11]. In 2005, the National E-Health Transition Authority (NEHTA) was founded through funding from the Council of Australian Governments, which is the authority that is responsible for promoting access to e-Health sectors at the national level. For document exchange in the national central system, the Integrating the Healthcare Enterprise (IHE) Cross-Enterprise Document Sharing (XDS) standards were defined as the basic system, and the HL7 CDA was applied to standard HIE forms. Personal information protection in Australia is accomplished through a legal system that regulates the public and private sectors via a single legislative act [12,13].Health Information Exchange Assignment Paper

Korea has also made progress in the digitization of hospital tasks, and its online HIE system has been expanding between cooperating healthcare organizations. This study aimed to identify issues and considerations that arise in relation to the implementation and operation of online HIE systems. Thus, this study may provide insights to assist in the implementation of other online HIE systems through the identification of problems and possible solutions.

an be overcome.

HIE use is increasing across the nation, with more providers realizing the benefits it can provide in patient care. For example, the Statewide Health Information Network (SHIN-NY) saw its HIE use of admission, discharge, and transfer (ADT) notifications grow by 95 percent among users from 2016 to 2017.

Researchers determined that ADT notification utilization increased by 95 percent between 2016 and 2017, with query-based health data exchange rising by 102 percent, according to findings from the New York eHealth Collaborative (NYeC).

When healthcare organizations understand the benefits of proper HIE use, it can help them work toward a more seamless and secure process.

IMPROVING PATIENT CARE THROUGH HIE USE

Expanded HIE use can provide numerous benefits to both patients and providers, helping healthcare work toward its goal of interoperability in the transition to value-based care.

ONC released its Trusted Exchange Framework and Common Agreement (TEFCA) draft in early 2018, designed to streamline patient health data access and exchange per provisions of the 21st Century Cures Act.

Having a single onramp to interoperability is a key TEFCA goal, along with improving patient data access, encouraging population-level data exchange, and having open and accessible application programming interfaces (APIs).

“The draft Trusted Exchange Framework we issued today reflects the successes and challenges already existing in the exchange of health information and is designed to help guide the nation on its path to interoperability for all,” National Coordinator for Health IT Don Rucker, M.D., said in a statement with TEFCA’s draft release.

“The principles and direction we released today, combined with the support of providers, existing health information networks, health IT developers, and federal agencies, are designed to help improve patient care, care coordination, and the overall health of the nation,” he continued.

Improving rural health outreach, developing effective responses to public health crises, and overcoming patient matching problems are just a few specific ways HIE use can help with patient care.Health Information Exchange Assignment Paper

Alabama One Health Record joined the Strategic Health Information Exchange Collaborative (SHIEC) earlier this year in an effort to strengthen patient care delivery and health data access options for patients living in rural and underserved areas.

Alabama Medicaid Agency Director of Health Information Technology Gary Parker explained that joining SHIEC would help Alabama One Health Record expand EHR utilization, care access, and telehealth capabilities.

Individuals who are displaced by natural disasters such as hurricanes and tornadoes will also benefit from the change, ensuring that HIE services can be properly utilized.

“By working together, our HIE members are uncovering ways to better serve vulnerable populations and provide valuable support in emergency preparedness and response to natural disasters, for example,” SHIEC CEO Kelly Hoover Thompson said in a statement. “We all get stronger through collaboration, and together, our members are playing an important role in addressing and overcoming health disparities across the country.”

Optimized HIE use can play a critical role during public health crises, including cases of natural disasters displacing individuals.

For example, such situations often create a sudden and pressing need to quickly access patient EHRs for efficient care delivery, Petaluma Health Center CMIO Danielle Oryn previously explained to EHRIntelligence.com.

Oryn worked with others at the Sonoma County-based Federally Qualified Health Center (FQHC) during the northern California wildfires that took place in 2017.Health Information Exchange Assignment Paper

Health center officials used the eClinicalWorks EHR to issue notifications that the facility was open, while providers utilized the health center’s connection to Surescripts for prescription histories access. Additionally, providers accessed medication lists for patients who didn’t normally receive treatment at Petaluma.

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“We’re part of a health information exchange with the other community health centers in our region,” Oryn said. “We have that set up through eClinicalWorks. Many of the health centers around this region use eClinicalWorks. So we are able to see some continuity of care information which includes medication lists, problem lists, and allergies.”

Ensuring health data privacy and security throughout the entire data exchange process is often a key pain point for providers. Organizations need to adhere to all federal and state regulations with data security, while still allowing for data to flow freely as needed for patient care.

The HIPAA Privacy Rule permits a covered entity to participate in PHI disclosure or to use the information or its own treatment, payment, and healthcare operations activities. Covered entities that collected or created the PHI are also allowed to disclose it to another covered entity for treatment or payment.

Additionally, the covered entity could use or disclose PHI for the health care operations of another covered entity that receives the information – to continue caring for the patient in question.

However, the growing number of cybersecurity attacks that compromise sensitive information – including patient PHI and PII – has fueled concern over health data security.

A 2017 Black Book survey found that 87 percent of adult consumers were unwilling to divulge all their medical information in Q4 2016. Digital health information being shared beyond a consumer’s physician and hospital was a top cited worry.

Over half – 57 percent – added that they were skeptical of potential benefits to certain technologies being utilized by a hospital, physician, or ancillary provider.

Eighty-nine percent of those surveyed stated that they in fact withheld information from their provider in 2016. Of those individuals, 93 percent admitted it was because of concerns over personal financial information security.

Physicians are becoming increasingly overwhelmed with the amount of data becoming available through data sharing though, which can lead to provider burden and in effect, less effective patient care.

Reduced data sharing barriers in current HIPAA regulations could help reduce that burden, according to the American Hospital Association (AHA). Restricting patient data sharing for “health care operations” can impact quality assessment and improvement activities, such as outcomes evaluation, AHA explained in a 2017 letter to the House Ways and Means Health Subcommittee.

“The challenge that strict regulatory prohibition poses in the integrated care setting is that patients frequently do not have a relationship with all of the providers among whom information should be coordinated,” AHA wrote. “A clinically integrated setting and each of its participating providers must focus on and be accountable for all patients.”Health Information Exchange Assignment Paper

The CMS’ Patients Over Paperwork initiative also hopes to help reduce administrative burden and physician burnout. Having a collaborative process for evaluating and streamlining regulations to minimize regulatory burden, increase efficiency, and improve the beneficiary experience will benefit providers and patients, according to CMS.

“As we talk about regulatory issues in burden one issue we’ve heard about over and over again around many communities is the issues around medical records and interoperability,” CMS Administrator Seema Verma explained at the 2017 ONC Annual Meeting. “Many of our providers talk about the system that they are working with and say it was not built for them in terms of how they are delivering care to their patients. It is more suited to a billing system.”

Having all healthcare stakeholders involved will be key to reducing administrative burden, improving interoperability, and strengthening health data exchange options. This will also be necessary in creating a healthcare system that focuses on value-based care and ensuring that patients are put first.

Additionally, focusing on healthcare data security needs can reassure patients that their data will remain protected, even in the health data exchange process. Organizations should also remain current on the latest federal regulatory changes that could impact how information can be used and disclosed.Health Information Exchange Assignment Paper

Electronic Health Information

The reality is that there is more electronic health information being exchanged between hospitals and physicians now than ever before. This is a step in the right direction because it eliminates handwritten notes. It also helps to eliminate the “word of mouth” discussions on a patient’s care that might never be officially documented.

Many physicians and hospitals are even having patients fill out their forms on a tablet in the waiting room. The benefit to this is that it’s going directly into an electronic system. It doesn’t depend on a data entry person to have to read someone else’s writing and then get it into the system. It saves a step, eliminates a lot of human error, and improves productivity.

The Relationship Between Health Data and Health IT Interoperability

It’s important to understand what health information exchange means and how the sharing of information can vary.

Health information exchange ultimately involves the exchange of all health-related information. This includes not only basic medical records but also laboratory results, clinical summaries, medication lists, and much more. Hospitals are already doing a great job of electronically exchanging this information.

Unfortunately, when it comes to office-based physicians, the exchange of information is not as strong. The information isn’t being sent to providers outside of their organization and health information isn’t being shared as extensively as it should be.

When interoperability is not part of the equation, patient healthcare suffers. It’s important for doctors and other medical providers to have the information that they need at the point of care. If they lack certain information, they need to spend more time obtaining the information – which can have a negative impact on the care provided to the patient.Health Information Exchange Assignment Paper

Health Information Exchange

The health information exchange is broken out into several categories: sending, receiving, finding, and integrating. It’s not enough to lead to send data. It needs to be received, found easily, and integrated into the medical records. If any one of the categories lacks, it poses problems in the health care provided as well as the overall productivity of the staff.

Interoperability is so important because it ensures that doctors, surgeons, and other medical providers have the information that they need in order to provide sufficient care. There’s the importance of being able to send, receive, fine, and integrate all of the data that is received from another location. Studies have shown that plenty of healthcare facilities are able to send and receive the data. The problem is being able to find the data and integrate it. Much of this has to do with it not being electronic and not being in a suitable format. The studies have looked at small hospitals, medium and large hospitals, critical access hospitals, rural hospitals, and more.

Health Information Exchanges need to take advantage of the latest tools and techniques that pervade modern information solutions; not lagging behind non healthcare sectors. True interoperability can have a significantly positive impact on the healthcare industry. A bottom-up approach needs to be taken when it comes to exchanging health data and making sure that it is accessible and usable.Health Information Exchange Assignment Paper

Each and every healthcare facility needs to adopt interoperability in order for it to truly be effective. Plenty of medical networks that have interoperability running through them have already proven how beneficial it is to have full data records at their fingertips.

Electronic health information exchange (HIE) is improving the quality and efficiency of healthcare by allowing healthcare providers to access and share patient medical information via computer.

The importance of Healthcare Information Exchange (HIE) is at an all-time high that is continually evolving to improve the quality and timeliness of care for patients. Access to medical records gives those providing care an understanding of the patient’s health history. Typical information that can be found in a primary care medical record includes but is not limited to:

Preventative therapies,
Demographic details,
Biographical details,
Significant illness,
Chronic conditions,
Lab results,
Medications, and
Hospitalization specifics

Providing accessibility and understanding of this information across all provider types at critical times allows a physician to obtain knowledge across the board regarding the patient to make the best decisions for his or her health. The electronic medical record (EMR) has been embraced by many and supported by the Centers for Medicare & Medicaid Services (CMS), providing available access to share needed information in compliance between provider and health plans within Health Insurance Portability and Accountability Act (HIPAA) standards.Health Information Exchange Assignment Paper

Not only are medical records important to physicians, but they also play a crucial role to health plans. A health plan is tasked with ensuring all physicians, in and out of network, are caring for members with optimal quality. This is most commonly done through processes governed by CMS such as the Healthcare Effectiveness Data and Information Set (HEDIS^®), Star Ratings, and risk adjustment. Specific to risk adjustment, medical records allow health plans to ensure the risk of members is appropriately calculated and fully supported by a valid medical record that could withstand a risk adjustment data validation (RADV) audit by CMS and/or the Department of Health and Human Services (HHS).

Unfortunately, there have historically been several barriers to the effective exchange of health information between plans and providers, including:

Provider participation/consent
Management of unstructured data
Viability of existing file formats for risk adjustment

Therefore, it’s important to ensure your organization is addressing these areas when launching an HIE initiative. One leading health technology company, Ciox Health, recently launched a multimodal clinical data acquisition and aggregation solution, called HealthSource,that tackles these traditional barriers. Ciox’s HealthSource leverages both the shift to collaborative value-based contracting and the company’s existing trust foundation (as the largest release of information services vendor for providers) and employs automation, including natural language processing and artificial intelligence, to expedite authorized clinical information exchange. As clinical information can be found in both structured data (demographics, lab values, etc.) and unstructured data (medical records images), Ciox applies technology-based processes to enable conversion to structured data to create a unified member-centric data repository. Further, as the largest intermediary of HIE, Ciox has worked closely with leading EMR vendors to ensure the records themselves contain the requisite chart elements to support risk adjustment and other health plan uses.Health Information Exchange Assignment Paper

In an announcement recently released by the company, CEO Paul Roma stated, “We believe that when clinical data can move easily and transparently between stakeholders, the entire health system works better, and most importantly, doctors and patients benefit.” Roma said the new suite of applications is meant to integrate “advanced and highly secured technologies into authorized medical data sharing operations,” offering healthcare organizations an improvement over the “costly and obsolete way health information is accessed and consumed today.”

Sounds great, right? Right. Until you realize that all states are at different stages with HIE deployment at this time. And, those HIE organizations that are actively deploying are not all alike. Each may share common service offerings but most are different with their data sharing activities.

What are some states doing with HIE? Recently, Alpine Urology, a Boulder-based physician office, began actively receiving time-sensitive test results and other important patient data through the HIE maintained by the Colorado Regional Health Information Organization (CORHIO). This is the first physician practice in Boulder County and across Colorado’s Front Range to use data provided by Colorado’s statewide HIE. When completely built out, the HIE will allow healthcare providers across Colorado’s Front Range, Eastern Plains and eastern mountain communities, such as San Luis Valley and Summit County, to more quickly and easily exchange patient data than the paper-based methods that are common today. Through use of CORHIO’s network, physicians and other medical care providers have access to important health information about their patients including hospital discharge notifications; lab test results; x-ray, MRI and other imaging reports; physician transcription reports and referral information. Later, the network will be upgraded to include patient medication lists, allergies and immunizations.

As another example, CliniSync, Ohio’s statewide health information exchange, blends the concepts of clinical data with the synchronicity that will allow a physician to access information from different entities for one patient, all at the same time. While some physicians, hospitals and healthcare professionals in Ohio can exchange patient information regionally or within a health system, this new exchange will go statewide, allowing medical professionals in different regions to electronically share information about a patient they have treated such as radiology reports, lab results, and other patient data.Health Information Exchange Assignment Paper

While just two examples of HIE activity nationwide, health IT professionals and industry efforts must work together to ensure that the building blocks exist to grow and nurture continued development and sustainability in HIE organizations nationwide.
And HIMSS can help with the many tools and resources that are available to organizations in pursuit of implementing health information exchange activities. Check out the various tools on the HIMSS HIE website: there are the monthly HIELights Newsletter , the HIE Toolkit that contains a wealth of information like white papers, technology solutions, and evaluation tools, to name a few, and the HIMSS HIT State Dashboard that includes a visual representation of HIE-related initiatives through the U.S. across a variety of project types. And this is only a sample.

At HIMSS12, health IT professionals from across the county will gather at the symposium on HIE: The Year of Implementation, Collaboration, and Beyond. And it is here that health IT professionals will network and problem solve about the many aspects of implementing and sustaining an HIE with national luminaries like Doug Fridsma, MD, PhD, Director, Office of Standards and Interoperability, Office of the National Coordinator; Dr. Seth Foldy, FAAFP, MD, MPH, Director of the Public Health Informatics and Technology Program Office at CDC, Centers for Disease Control and Prevention; Jan Lee, MD, Executive Director, Delaware Health Information Network, and others.

Electronic Health Records (EHRs) have become a very important and integral part of the healthcare system. Despite the initial hesitation to switch to the EHR, overwhelming majority of organizations which have switched to EHR cannot imagine going back to paper. EHRs improve efficiency and increase reimbursements while improving patient care. As providers become more fluent with the technology, EHRs can help physicians with decision making and influence the way a patient is treated.Health Information Exchange Assignment Paper

In our national journey to transform healthcare, Health Information Exchange (HIE) is part of a federal EHR Meaningful Use (MU) standard. The idea is that all community providers (public health, private clinics, hospitals etc.) will connect their EHR to HIE. But what exactly is a HIE?

In a nutshell HIE is a hub which allows the relevant parties to share information electronically rather than via old fashioned paper fax. The image displayed above shows how all clinics can connect and share patient information through the HIE.

All EHRs connected to a HIE can share information via federally defined standards of CCR (Continuity of Care Record) and CCD (Continuity of Care Document). This is the standard which all federally certified EHRs must follow.

Any federally certified EHR which is connected through the HIE can (if permitted) receive/send information between the EHR and the HIE. Thus, the provider can send and receive electronic information with any community provider which is connected to the HIE. Timely information received (e.g. a patient discharge summary from a community hospital), after review by local health department staff, can be brought into a patient’s chart as electronic data elements. This could further influence a patient’s care and:

Save time by avoiding re-admissions
Get away from dealing with paper and faxes
Save money by avoiding duplicate testing
Improve diagnoses
Potentially save lives by avoiding medication errors.
Improve public health Health Information Exchange Assignment Paper

As Stage 2 of Meaningful Use gets deployed, HIEs become pivotal game changers. Without HIEs, no EHR can be interoperable and interoperability is the driving force of Stage 2 and Stage 3 MU. Therefore, no eligible provider (EP) will qualify for their stage 3 MU incentives. “Technology and data play an increasingly important role. EHRs certainly need to be connected to a Health Information Exchange” said Dr. Robin Cummings, former Medicaid Director, NC Department of Health & Human Services.

In a recent ONC news release, Karen DeSalvo, M.D., M.P.H., M.Sc., National Coordinator for health IT is quoted, “As we move beyond [EHR] adoption to a learning health system where information is available when and where it matters most, it is important to ensure greater care coordination at the community level.” To emphasize the importance of HIE’s role, the Office of the National Coordinator for Health Information Technology (ONC) granted $38 million to, in part:

Expand the adoption of HIE technology, tools, and services
Facilitate and enable the send, receive, find, and use capabilities of health information across organizational, vendor, and geographic boundaries
Increase the integration of health information in interoperable health IT to support care processes and decision making

If your EHR system is not federally certified meeting the interoperability requirement for certification, or is purposefully blocking the exchange of information, you will not achieve maximum benefits from the EHR or a HIE, nor will you receive the incentive payout. Challenge your vendor or find a new EHRbecause “we’re about two decades behind the banking industry and we’ve got to catch up. We’ve just got to do it” says Cummings.

What is HIE?

Electronic health information exchange (HIE) allows doctors, nurses, pharmacists, other health care providers and patients to appropriately access and securely share a patient’s vital medical information electronically—improving the speed, quality, safety and cost of patient care.

Despite the widespread availability of secure electronic data transfer, most Americans’ medical information is stored on paper—in filing cabinets at various medical offices, or in boxes and folders in patients’ homes. When that medical information is shared between providers, it happens by mail, fax or—most likely—by patients themselves, who frequently carry their records from appointment to appointment. While electronic health information exchange cannot replace provider-patient communication, it can greatly improve the completeness of patient’s records, (which can have a big effect on care), as past history, current medications and other information is jointly reviewed during visits.

Appropriate, timely sharing of vital patient information can better inform decision making at the point of care and allow providers to

Avoid readmissions
Avoid medication errors
Improve diagnoses
Decrease duplicate testing

If a practice has successfully incorporated faxing patient information into their business process flow, they might question why they should transition to electronic health information exchange. Many benefits exist with information exchange regardless of the means of which is it transferred. However, the value of electronically exchanging is the standardization of data. Once standardized, the data transferred can seamlessly integrate into the recipients’ Electronic Health Record (EHR), further improving patient care. For example:Health Information Exchange Assignment Paper

If laboratory results are received electronically and incorporated into a provider’s EHR , a list of patients with diabetes can be generated. The provider can then determine which of these patients have uncontrolled blood sugar and schedule necessary follow-up appointments.1

There are currently three key forms of health information exchange:

Directed Exchange – ability to send and receive secure information electronically between care providers to support coordinated care
Query-based Exchange – ability for providers to find and/or request information on a patient from other providers, often used for unplanned care
Consumer Mediated Exchange – ability for patients to aggregate and control the use of their health information among providers

The foundation of standards, policies and technology required to initiate all three forms of health information exchange are complete, tested, and available today. The subsequent sections provide detailed information and example scenarios for each of the three forms.

Directed exchange is used by providers to easily and securely send patient information—such as laboratory orders and results, patient referrals, or discharge summaries—directly to another health care professional. This information is sent over the internet in an encrypted, secure, and reliable way amongst health care professionals who already know and trust each other, and is commonly compared to sending a secured email. This form of information exchange enables coordinated care, benefitting both providers and patients. For example:Health Information Exchange Assignment Paper

A primary care provider can directly send electronic care summaries that include medications, problems, and lab results to a specialist when referring their patients. This information helps to inform the visit and prevents the duplication of tests, redundant collection of information from the patient, wasted visits, and medication errors.

Directed exchange is also being used for sending immunization data to public health organizations or to report quality measures to The Centers for Medicare & Medicaid Services (CMS).

Query-based exchange is used by providers to search and discover accessible clinical sources on a patient. This type of exchange is often used when delivering unplanned care. For example:

Emergency room physicians who can utilize query-based exchange to access patient information—such as medications, recent radiology images, and problem lists—might adjust treatment plans to avoid adverse medication reactions or duplicative testing.
If a pregnant patient goes to the hospital, query-based exchange can assist a provider in obtaining her pregnancy care record, allowing them to make safer decisions about the care of the patient and her unborn baby.

Consumer-mediated exchange provides patients with access to their health information, allowing them to manage their health care online in a similar fashion to how they might manage their finances through online banking. When in control of their own health information, patients can actively participate in their care coordination by:Health Information Exchange Assignment Paper

Providing other providers with their health information
Identifying and correcting wrong or missing health information
Identifying and correcting incorrect billing information
Tracking and monitoring their own health1

Health information exchange (HIE) is the mobilization of health care information electronically across organizations within a region, community or hospital system. In practice the term HIE may also refer to the organization that facilitates the exchange.

HIE provides the capability to electronically move clinical information among different health care information systems. The goal of HIE is to facilitate access to and retrieval of clinical data to provide safer and more timely, efficient, effective, and equitable patient-centered care. HIE is also useful to public health authorities to assist in analyses of the health of the population.

HIE systems facilitate the efforts of physicians and clinicians to meet high standards of patient care through electronic participation in a patient’s continuity of care with multiple providers. Secondary health care provider benefits include reduced expenses associated with:

the manual printing, scanning and faxing of documents, including paper and ink costs, as well as the maintenance of associated office machinery
the physical mailing of patient charts and records, and phone communication to verify delivery of traditional communications, referrals, and test results
the time and effort involved in recovering missing patient information, including any duplicate tests required to recover such information Health Information Exchange Assignment Paper

According to an internal study at Sushoo Health Information Exchange,^[1] the current^[when?] method of exchanging patients’ health information accounts for approximately $17,160 of expenses annually for a single-clinician practice.

Formal organizations are now^[when?] emerging to provide both form and function for health information exchange efforts, both on independent and governmental or regional levels. These organizations are, in many cases, enabled and supported financially by statewide health information exchange grants from the Office of the National Coordinator for Health Information Technology. These grants were legislated into the HITECH components of the American Recovery and Reinvestment Act of 2009.^[2] The latter organizations (often called Regional Health Information Organizations, or RHIOs) are ordinarily geographically defined entities which develop and manage a set of contractual conventions and terms, arrange for the means of electronic exchange of information, and develop and maintain HIE standards.^[3]

In the United States, federal and state regulations regarding HIEs and HIT (health information technology) are still being defined. Federal regulations and incentive programs such as “Meaningful Use”, which is formally known as the EHR Incentive Program,^[4]^[5] are rapidly changing the face of this relatively new industry. In addition to changes driven by federal activities, the lessons learned in the ongoing implementation of some state-sponsored HIEs (such as the North Carolina HIE^[6]) and the fluctuating nature of health care regulations at the level of the state governments themselves are leading to additional refinement. However, HIEs and RHIOs continue to struggle to achieve self-sustainability and the vast majority remain tied to federal, state, or independent grant funding in order to remain operational. Some exceptions exist, such as the Indiana HIE.

The Health information exchange incorporates bylaws that have specified procedures and policies and they are framed in accordance with the federal as well as the state law. The is no standard governance prototype that exists for the health information exchange hence all involved organizations should have the basic understand of the Health information exchange governance that directly relates to them. A formal management structure is crucial to the organization of the Health information exchange facilities. The management assists in strategic planning, setting of goals and objectives, mission, policies, and the procedures that will insure functionality of the exchange program. Optional input (opt-in) and output (opt-out) models are established after the governance structure has been laid down. In optional input model, the patients or clients themselves decide on whether to authorize the exchange of their health information with the Health Information exchange program. The specific health information organization provide the agreement terms to the clients before they allow their information to be shared. A proper and effective process is utilized to choose the vendor (Davis & LaCour, 2014).Health Information Exchange Assignment Paper

The Central Illinois Health Information Exchange (CIHIE) is community-based nonprofit making organization that was founded in 2010 and consists of the healthcare providers from Illinois. The organizations is provides secure health record exchange to ensure the best patient care is provided in the region. The collaboration of the healthcare providers through CIHIE has facilitated unity of working together for the healthcare providers to realize the common benefit of the patients and the society. The main goal of the Central Illinois Health Information Exchange organization is to provide a win-win solutions in sharing of cost and providing quality customer service by healthcare providers in Illinois (Cihie.org, 2015).

Currently the CIHIE organization use the MEDIOS software to offers services such as connect, public health reporting, Direct Alert services, and interface for service yearly subscription costs. The connect service provides a secure way of retrieving and requesting the health records of a patient electronically. The transported patient data is encrypted and is transported through a secured network. Above all, it is an up to date record of the patient. The organization provides specified type of public health reporting in Illinois. Instant messaging services are provided to their clients by the organization through accredited vendors. Connection subscription is provided to the clients at a certain fee per duration. Encrypted messaging services are provided to physicians and medics at a predetermined subscription cost. The organization is founded under the Illinois Health Information Exchange and Technology Act. The organization also receives award funds from the United States government through the HIE challenge Grant program in order to participate in developing solutions in the HIE field (Cihie.org, 2015).

Health information exchange (HIE) is the electronic transmission of healthcare-related data among medical facilities, health information organizations — companies that oversee and govern the exchange of this data — and government agencies according to national standards.

The purpose of HIE is to promote the appropriate and secure access and retrieval of a patient’s health information to improve the cost, quality, safety and speed of patient care. While HIE typically refers to the act of exchanging information between two or more healthcare organizations or providers, it may also refer to an organization that is responsible for facilitating the exchange.Health Information Exchange Assignment Paper

In 2004, the ONC (Office of the National Coordinator for Health Information Technology) created the Nationwide Health Information Network (NHIN) to establish standards, services and policies for HIE. Federal agencies, HIEs and healthcare providers agreed to adopt NHIN standards for secure HIE at a local and national level. NHIN became known as the eHealth Exchange in 2012.

According to the eHealth Exchange, participants agree to send health information to other participating organizations, match patients to their data without the use of a national patient identifier, and find and request copies of healthcare information from other participating organizations when permitted by law and policy.

Why health information exchanges are important

HIE helps enable care coordination, which the Agency for Healthcare Research and Qualitydefines as “the deliberate organization of patient care activities between two or more participants involved in a patient’s care to facilitate the appropriate delivery of healthcare services.” This enhanced communication offers healthcare providers a more complete view of a patient’s health and reduces the risk of errors, duplicate treatments or tests, and readmissions, while improving patient safety and outcomes.

HIE can be used to improve population health, as well. Healthix, a New York-based HIE, helped the New York State Department of Health’s AIDS Institute monitor and manage the HIV-positive population in that state. Long-term care is critical for this population, so Healthix identified HIV-positive individuals and the care they were receiving. The Department of Health used that data to focus on public health surveillance initiatives that would provide links to care and necessary therapies for the HIV-positive population.Health Information Exchange Assignment Paper

There are several benefits of HIE for patients. For example, HIE enables patient engagement, offering patients an electronic copy of their medical information that they can share with their healthcare providers. Research has also found that HIE use can improve patient-provider communication and patient satisfaction.

How data is stored and shared

There are three HIE architecture types: federated or decentralized, centralized, and hybrid.

In a federated model, health records are stored in independent databases or repositories. Each healthcare organization or provider maintains ownership of and control over the health records; access to the health record is granted to users only when needed.

In a centralized model, health records are collected from participants in the HIE and stored in a single repository or database.

A hybrid model combines centralized and decentralized aspects.

There are two methods of data exchange in HIE: push and pull.

When a message or document, such as a lab result, is sent from one participant to another, this is called a push exchange. When a provider searches for or queries a patient’s health information, this is called a pull exchange.

The types of data that can be exchanged include clinical, claims, public health, quality and reporting data.

Compliance with HIPAA and other acts

All HIEs must, at a minimum, comply with HIPAA. According to the U.S. Department of Health and Human Services (HHS), the HIPAA Privacy Rule establishes a federal baseline that is applied consistently to covered entities across all 50 states, but it does not pre-empt individual state laws that place greater privacy rights and protections on the information in an exchange.

The Health Information Technology for Economic and Clinical Health (HITECH) Act expands the federal protections for personal health information (PHI) privacy and security under HIPAA and extends business associate status to HIEs. HITECH also requires electronic health records to be “connected in a manner that provides for the electronic exchange of health information to improve the quality of healthcare.”

Intermountain Healthcare CIO Marc Probst discusses the importance of standards

States may have either an opt-in or opt-out consent policy for participation in an HIE, although there are some states that have no policy.

In states with an opt-out policy, patients may be automatically enrolled in the HIE, but can choose to opt out of having their information stored or disclosed by the HIE.

Opt-in states require patient consent before patient health information can be stored or disclosed by the HIE. There may also be additional requirements, such as an opt-in for sensitive PHI or an opt-in to allow a new healthcare provider to access PHI.

According to the American Health Information Management Association, other laws that affect HIE include:

Privacy Act of 1974
Family Educational Rights and Privacy Act
Gramm-Leach-Bliley Act
Food, Drug and Cosmetic Act

The exchange of patient data brings with it the risk of breaches, either through unintended access or hacker theft.

In July 2016, the Codman Square Health Center in Dorchester, Mass., notified patients that a person accessed an HIE — the New England Healthcare Exchange Network — without authorization.Health Information Exchange Assignment Paper

The individual, an employee of an outside vendor, used a Codman employee’s credentials to obtain access to the HIE and patient information, such as names, addresses and dates of birth. In addition to Codman’s 140 patients, the individual also accessed the records of 4,000 other patients in the HIE.

Challenges with HIE

In a 2014 report to Congress, the U.S. Government Accountability Office (GAO) found four specific challenges related to HIE.

Insufficient standards. Standards for electronically exchanging information within EHRs exist, but providers reported that the standards were insufficient in some areas. GAO concluded that information that is exchanged electronically between providers must adhere to consistent standards in order to be interpreted and used in the EHR.
Variations in privacy rules. Providers reported that exchanging health information with providers in other states can be difficult because of a limited understanding of variations in state privacy rules.
Difficulty of accurately matching patients to their health records. Providers reported that they were unable to accurately and efficiently match patients to their records when exchanging health information electronically.
Cost of exchanging health information. Providers reported challenges covering the costs associated with HIE, including the cost to participate in state or local health information organizations, as well as per-transaction fees charged by some HIE vendors. Health Information Exchange Assignment Paper