The term Health Information Exchange (HIE) can refer to the actual process of exchanging information related to healthcare (the verb) or an HIE organization (the noun). The basic structure of an HIE organization includes a location where data can be stored and retrieved, either from a central database maintained by the HIE, or more often from a variety of databases that are native to other healthcare organizations, such as hospitals, clinics, emergency rooms, immunization registries, laboratories, radiology centers, nursing homes, and other stakeholders. In order for the HIE to provide access to this information, the HIE must have interfaces to a variety of healthcare information technology platforms, including electronic health records and in some cases other HIEs.
HIE organization fundamentals include:
- User authentication
- Patient identification
- The ability to send and receive images, free text, codified data (e.g., ICD or SNOMED CT), standardized health information containers (e.g., the CCD, cCDA, HL7, etc.) and other types of information
- Policies regarding access and use of information by healthcare providers and others, including compliance with HIPAA and other regulations tied to protecting privacy.
- Software that supports the exchange of healthcare information, including interfaces to dozens of disparate health information technology systems.
- Security protocols
- Marketing team
- Support team
- Interface team
- Revenue model
- Business Model: Perhaps the biggest challenge with starting and maintaining an HIE organization is the business model for HIE. In the majority of instances healthcare stakeholders have not adequately recognized the value of HIE to the point where they have offered financial support. For this reason a high percentage of HIEs fail once their grant or seed funding has been consumed. However, initiatives such as Accountable Care Organizations and the Patient-Centered-Medical-Homes depend on real-time access to data and are driving some HIE efforts.
- Limited Use of Standards: The lack of implemented/required standards for health information exchange has also limited the value of information that can be exchanged. The Stage 2 and then Stage 3 phases of the Meaningful Use of electronic health records does offer some promise of standards being more widely adopted. This in turn would mean that HIE and EHR software vendors would be able to develop interfaces at a fraction of their current cost.
- Data integrity: A high percentage of the data available in HIE systems will be in the form of claims data, which has inherent challenges related to the completeness and accuracy of the information it conveys. This has potential patient safety ramifications and HIE organizations are advised to have a patient safety program in place that includes how they address their role in the transfer of data that may or may not be clinically accurate.
Health Information Exchange and HIE organizations have a vital role in healthcare, in particular as quality of care and population health initiatives continue to emerge as major drivers. The gradual incorporation of standards will also allow information to flow more smoothly and with higher levels of integrity at a fraction of its current cost. The future of HIE is bright from the standpoint of it being a key component of any successful community based healthcare initiative, however, its cost of operations will need to be absorbed as an operational expense by other more profitable enterprises.
The information contained in this article represents the opinions of its author: Michael Stearns, MD
©Michael Stearns, all rights reserved