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What is Health Information Exchange?

Not so many years ago, health records were exchanged between patients and providers via fax, mail, or through a face-to-face (or hand-to-hand) exchange.

There’s nothing wrong with face-to-face interaction, of course. Patients and providers should always communicate in person when possible. And there was nothing wrong with faxes and mail either, aside from torn or damaged pages, smeared type, wrong addresses and so on.

Even with the inadequacies of fax and mail, there were few other options available.

Enter electronic health records (EHR).

EHR gives providers access to clear, accurate and up-to-date patient information on their desktops, laptops, tablets or smartphones.

Clear, accurate and up-to-date records often must be shared among various healthcare providers and healthcare organizations that a patient may use. This is where health information exchange (HIE) comes into play.

The term HIE is used as a verb and a noun, describing both the process of and the organizations that perform the secure transfer of healthcare data.

The actual process of HIE can vary depending on the type of organization overseeing the exchanges.

There are three different methods of HIE:

  • Directed Exchange: Sending and receiving information between healthcare providers
  • Query-based Exchange: Healthcare providers searching and asking for information on a patient from another healthcare provider
  • Consumer Mediated Exchange: Patients are able to collect and control their personal health information.

According to the Healthcare Information and Management Systems Society (HIMSS), an organization dedicated to improving healthcare through information technology, some of

the benefits of HIE are:

  • Care coordination: Data moves in real time across platforms and among providers in real time.
  • Record Locator Services/Master Patient Indexes: HIE allows for one continuous record, facilitating patient identification between multiple providers.
  • Data exchange: HIE enables data transfers to take place instantly on multiple providers and settings.
  • Clinical messaging: Among HIE’s standard services are lab results, emergency room notes, medication lists, discharge summaries, progress notes, radiology results and surgical notes.
  • New care delivery methods: HIE is essential to new care delivery methods such as Accountable Care Organizations and Patient-Centered Medical Homes.

Rather than set a national model for HIEs, theState Health Information Exchange Cooperative Agreement (State HIE) Program provided funds to U.S. states and territories to set up programs tailored to each area’s individual needs. So an organization’s HIE will be designed depending on its needs as well as what’s available in its locale.

HIEs generally fall into one of the following categories, according to HIMSS:

  • Statewide HIEs: These are run by a state’s government, or they may be the State’s Designated Entity (SDE), either a component of the government or a non-profit organization chosen by the state to manage HIE.
  • Private or proprietary HIEs: This type of HIE focuses on a single community or network, often within a single organization, and includes its management, finance and governance. Some examples of this are hospital networks, payer-based HIEs and disease-specific HIEs.
  • Hybrid HIEs: This would include collaborations between organizations, such as an Accountable Care Organization and a vendor network, within a state or region.
  • Regional or Community HIOs: Mostly non-profit, these are inter-organizational and dependent upon many funding sources.

Why Implement HIE?

Regardless of the type of HIE, the reasons to implement HIE are many. Among them are:

  • Reducing errors to improve quality and safety of care
  • Encouraging patients to take part in their own health care
  • Eliminating unnecessary paperwork
  • Providing caregivers with clinical decision support tools
  • Eliminating redundant or unnecessary testing
  • Improving public health monitoring and reporting
  • Creating a potential feedback loop between health-related research and practice
  • Increasing efficiencies in deployment of new healthcare technology and services
  • Improving interoperability among EHRs maintained by individual physicians and organizations
  • Lowering healthcare costs.

HIE continues to be a work-in-progress. A 2016 U.S. Department of Health and Human Services report concluded that “there is no one-size-fits-all solution with HIE; instead, development and use of HIE is predicated on the state and local environments within which it exists.”

While some states, such as New York and Colorado, have high participation rates, other states remain in the early stages. Adoption of HIE seems inevitable, though, and the government’s initiative should allow individual states to devise systems that suit their individual needs.

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