What is Health Information Exchange (HIE)?

Americans may live in a digital age, but with widespread secure electronic data transfer available, most medical information remains stored in paper form. Even today, file cabinets still line most medical office walls or sit like clutter in folders and boxes in patients’ homes. When medical professionals need to share pertinent patient data from these records, they must mail or fax it to their respective recipients or have the patients deliver the information themselves.

Fortunately, thanks to the advent and proliferation of health information exchange (HIE) both the medical community and consumers alike can finally employ modern digital technology to provide and receive, respectively, a higher quality of health care.

HIE - Health Information Exchange

Simply put, Health Information Exchange (HIE) is the transmission of health-related data among medical facilities, providers, and patients electronically. In stark contrast to traditional paper records, electronic HIE enables health care providers and professionals, from doctors and nurses to pharmacists and specialists, to properly and securely access and share critical medical information digitally.

As the US government Office of the National Coordinator for Health Information Technology (ONC) attests on it's website, HIE improves, “the speed, quality, safety and cost of patient care.”

Patient data contained in an HIE can include the following:

• Past medical history
  
• Current medications
  
• Laboratory orders and results
  
• Up to date progress notes
  
• Patient referrals
  
• Discharge summaries

Certainly, the electronic exchange of health information cannot completely replace communications between patient and provider. However, it can vastly improve the flow of vital health information to the provider who needs this information which will improve the quality of care and decrease the overall cost to the healthcare system.

Terminology

You’ll find the term HIE used as both a noun and a verb.

As a Noun

An HIE is any organization in the US that provides the services and technology for conducting the digital access and transfer of health information at either a regional, state, or national level. HIEs frequently work with communities directly to foster the secure, electronic sharing of health-related information.

As a Verb

HIE is the direct sharing of health-related information between two or more authorized entities electronically through standards of practice various stakeholders apply in the interest of informing health and health care.

Forms of Health Information Exchange

Three forms of HIE currently exist, each providing a different type of access to health information and in a different manner.

1. Directed Exchange

Through directed exchange, health care providers can simply and securely share patient data with other providers directly. The data is transferred in a reliable and securely encrypted format via the internet, and it is only sent between providers who already have a professional rapport. One way to think of directed exchange is as a secure email between two providers who already know and trust one another. Through directed exchange, providers and patients can benefit from more coordinated health care.

Two particular uses of directed exchange of late are to deliver quality-measure reports to the Center for Medicare and Medicaid Services (CMS) and immunization information to public health organizations.

2. Query-Based Exchange

Through query-based exchange, providers can seek and find specific health information about a patient from whatever appropriate clinical sources are available. Providers most commonly use this form of HIE to deliver unplanned care, such as in an emergency situation.

For example:

• An emergency-room physician may need to request x-ray information, current medications or problem lists for a patient unfamiliar to him or her.
  
• An obstetrician may request pregnancy records for a pregnant woman who goes into labor while traveling.
  

3. Consumer-Mediated Exchange

Through consumer-mediated exchange, patients can access their own medical information securely and easily online. Through this utilization of HIE, consumers can better manage their own health care, not unlike people who may use online banking to manage their finances.

Ways that patients can use consumer-mediated exchange to participate actively in the coordination of their own health care include:

• Giving other providers vital health information
  
• Finding and fixing missing or inaccurate information
  
• Monitoring and tracking their own health care

This allows for the patient to participate in their own care and increases satisfaction and accuracy of care.

Benefits

The fact that health information exchange is a growing practice among health care providers shows a clear recognition of its pressing need and invaluable benefits. These benefits of HIE are vast and varied, encompassing the patient, provider, and health care system alike.

Digital health information systems help ensure every person participating in a patient’s care, be they a primary-care practitioner, specialist, or emergency-room physician, is working from the same information. This helps to prevent costly and potentially dangerous errors, thereby cutting costs and improving health outcomes. If this modality saves even one life, it has proven it's benefit.

HIE also makes the entire process of health care more efficient. The sharing of data cuts down the time consuming effort of filling out repetitive forms and allows new providers or specialists to have health information prior to the visit. This increases the time the provider can spend with the patient instead of their paperwork. This method also allows for the direct-to-consumer delivery of follow-up instructions and appointment reminders. Prescriptions and medical supply orders can be delivered directly to the pharmacy or surgical supply store allowing for pre-authorizations to be completed and those products to be sent in a more timely manner.

Other key benefits of HIE include the following:

• Reducing medication mistakes, incorrect diagnoses, and other medical errors, thereby offering a way to improve the safety and quality of a patient’s care
  
• Eliciting greater involvement by patients in their own care, thereby increasing their knowledge and understanding of their health
  
• Eliminating needless paperwork and duplicate entries, thereby improving efficiency
  
• Eliminating needless or redundant testing
  
• Reducing recurring outpatient appointments for the same problems and preventing inpatient readmissions
  
• Giving caregivers the necessary support tools to make more effective clinical decisions regarding the care and treatment they provide
  
• Improving the monitoring and reporting of public health information
  
• Allowing for health-care practitioners and researchers to more easily and effectively provide one another the feedback necessary to advance both of their missions
  
• Enabling health-care service providers and related emerging technology to be more easily and effectively deployed
  
• Creating a technical support infrastructure to help leverage relevant state and national initiatives
  
• Lowering overall health-care costs

HIE also allows for easier and more efficient interoperability with EHRs (electronic health records) that a provider or organization already maintains. Specifically, it allows for health information contained in electronic form to be transferred between different parties utilizing different technologies securely and effectively without the need for special knowledge or effort on the part of the sender or recipient. It also facilitates complete authorized use of electronic health information under federal and state law and does not count as information blocking as section 3022(a) of the FDA's 21st Century Cures Act defines.

HIE makes use of data standardization practices to integrate a patient’s data uniformly into the individual practice's EHR. In other words, vital patient data appears identical no matter who entered the data into the EHR. This allows for the creation of a more comprehensive body of individualized patient health information.

For instance, if a provider receives abnormal laboratory test results, once they are input into the patient's electronic chart, the provider will have the ability to flag the abnormal values and properly schedule follow up visits, specialists consults and repeat laboratory tests to exceed the patient's needs and improve their overall care.

How to Start Implementing HIE in Your Own Practice

To build or join an HIE for your own practice or hospital system, the National Rural Health Resource Center recommends performing the following readiness assessment:

1. Identify and recruit the pertinent stakeholders in your practice or system, including the executive and management team, IT or applications director, and legal or compliance officer, as well as those outside your system.
   
2. Identify your current privacy and security concerns and gaps in your current standards of care.
   
3. Prioritize use cases for HIE within your system, develop appropriate benchmarks, and integrate these into your existing sustainability plan and operational assessments.
   
4. Evaluate the current operational environment within the system and develop goals for implementing the HIE, including determining proper procedures and requirements for governance and onboarding new partners.
   
5. Determine appropriate HIE workflows, and identify gaps in existing workflows that HIE can help to fill.
   
6. Evaluate the current IT environment, including interface and interoperability gaps, and determine ways for HIE to fill it.
   
7. Make the necessary assessments and adjustments for Stage 1 and 2 meaningful use adoption and attestation.
   
8. Determine the cost and return-on-investment related to each use case, and use that to develop an appropriate financial sustainability model and implementation timeline for incorporating HIE into your practice or system.
   

Conclusion

As previously mentioned, HIE is not meant to replace vital provider-patient communication, but rather to help make sure a patient’s health records are accurate and complete. When an individual’s health care today normally involves multiple providers and specialists, such assurances are paramount and can even mean the difference between life and death.

Driving more and more providers and practices to explore and employ HIE is the rise of new approaches to provider payment that emphasize coordination of care, meaningful use requirements for using certified EHR technology, and financial incentives from the federal government, among other motivators.

The technology, standards and policy are readily available to initiate the HIE in all of it's iterations in medical practices around the United States. Many local, regional, and state governments and non-profit agencies have already developed their own HIE networks. All over the country, accountable-care organizations are forming to advance local HIE models, and many EHR vendors and national health networks have started incorporating HIE into their offerings. This means health information exchange is only bound to become a more integrated and critical part of modern health care for everyone. As this format of digital health becomes more population, the hope exists that healthcare becomes more streamlined, safer and less costly.