Question

Describe HIE types & forms. Compare and contrast the various forms of HIE.

Do the requirements for HIE in “meaningful use” program make building a value proposition for HIE easier or more difficult?

Compare and contrast the HIE architectural styles. Which approach might be the most effective on a national scale?

Answer 1

ELECTRONIC HEALTH information Exchange:-

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:-

(I)Avoid readmissions

(Ii)Avoid medication errors

(III)Improve diagnoses

(Iv)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: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.

There are currently three key forms of health information exchange:

(1.)Directed Exchange – ability to send and receive secure information electronically between care providers to support coordinated care

(2.)Query-based Exchange – ability for providers to find and/or request information on a patient from other providers, often used for unplanned care.

(3.)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.

(1.)DIRECTED EXCHANGE:-

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: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).

(2.)QUERY-BASED EXCHANGE:-

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.

Learn more about the technology supporting query-based exchange.Web Site DisclaimersWeb Site Disclaimers

(3.)CONSUMER-MEDIATED EXCHANGE:-

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:

(a.) Providing other providers with their health information

(b) Identifying and correcting wrong or missing health information

(c)Identifying and correcting incorrect billing information

(d)Tracking and monitoring their own health.

Health Information Exchange Organization (HIO):-

A Health Information Exchange Organization (HIO) is an organization that oversees and governs the exchange of health-related information among organizations according to nationally recognized standards. The purpose of an HIO is to perform oversight and governance functions for HIEs.

The demand for electronic health information exchange among care professionals is growing along with nationwide efforts to improve the quality, safety, and efficiency of health care delivery. Meaningful use requirements, new payment approaches that stress care coordination, and federal financial incentives are all driving the interest and demand for health information exchange.

HIEs and HIOs can provide many important benefits for providers, patients and hospitals, such as:

(1.)Enhanced care coordination through communication between providers is of critical importance for patient care, and leads to improved outcomes and patient safety. It can also reduce or eliminate redundant and unnecessary testing.

(2.)Access to the right information, at the right time, for providers, patients and all other stakeholders.

(3.)Improved efficiency and reliability through the elimination of unnecessary paperwork and providing caregivers with clinical decision support tools.

(4.)Improved quality and safety through reduction of medication and medical errors.

The requirementsfor HIE in meaningful use " program make building a value proposition for HIE easier.The demand for electronic health information exchange among care professionals is growing along with nationwide efforts to improve the quality, safety, and efficiency of health care delivery. Meaningful use requirements, new payment approaches that stress care coordination, and federal financial incentives are all driving the interest and demand for health information exchange.

Meaningful use leveraged certified electronic health record (EHR) technology for multiple purposes. The Advancing Care Information category within HIE encourages meaningful use, but it still aims to achieve the same objectives, including:

(I)Improve quality, safety, efficiency, and reduce health disparities

(Ii)Engage patients and family

(III) Improve care coordination, and population and public health

(Iv)Maintain privacy and security of patient health information.

Health Information Exchange: Architecture Types:-

(1.) Centralized Model:-Centralized HIEs have a single Clinical Data Repository (CDR) that is maintained by the HIE authority, which are usually governed by representatives from each member hospital. The centralized architecture can be utilized on a regional basis,.

for example:- by hospital systems located in the same metro area.

Each member hospital electronically transmits agreed upon patient health information to the CDR, where it is securely stored and continually updated via interfaces that are connected directly to each hospital’s patient data repository, or health information system (HIS). Through these interfaces, patient data flows to the central authority, updating the appropriate records, and also back to each member hospital when the data is requested, which is usually done upon patient admit using a pre-defined unique set of patient identifiers, including social security number or last name.

The most interoperable HIE architecture, the centralized model costs the most to set up and maintain because it requires a large upfront investment in technology in the form of servers, which need to be monitored and stored in a secure, separate location. Additionally, each organization must have a fully functional EHR and utilize CCD documents.

(2.)Federated Model:-A Federated HIE model consists of a collection of clinical data repositories which are located remotely. In this example, Centralized HIEs agree to provide the overreaching state or central authority with their unique patient identifier information, which is stored in the state-wide HIE’s patient registry, or record locator service. In a Federated HIE (as opposed to Centralized HIEs) patient data is not stored in a centralized, accessible location. Patient information continues to be stored locally, with the Regional Central Authority in this example.

To retrieve patient data, member organizations send query messages to the HIE’s patient registry. The patient registry contains a “virtual roadmap” of where patient health records are located, searchable by a combination of unique patient identifiers such as a combination of identifiers including name, social security number, and others.

When a record is located in the registry, the state central authority transmits the record’s physical location back to the requesting organization. The requesting organization then must request the patient information from the facility where it is located. The facility storing the information can transmit the data to the requesting organization via secure e-mail, secure web services, or through a VPN connection.

The Federated HIE model is considered less interoperable than the Centralized HIE because it does not allow a simple exchange of information between facilities’ EHR systems. The requirement that a central record locator service is needed to keep track of numerous duplicate health records at multiple remote locations increases the complexity of locating a patient’s complete health history available and determining which information is the most up to date.

(3.)Hybrid HIEs:- In This national HIE architecture type could represent a combination of the seven HIEs that are participating in the EHR/HIE Interoperability Workgroup, a federally backed initiative to develop and test the standards and processes needed to create a national exchange of health information. In addition, the Nationwide Health Information Network, typically referred to as NwHIN, is working to lay the foundation for our national health system.

In this example Hybrid Artchitecture model, participating Federated HIE pilots (located in New York, California, Colorado, Maryland, Massachusetts, New Jersey, New York, and Oregon) request data similar to regional HIEs in the federated model, but, the location of records across states would be performed at a national level. In this example, a national authority, such as the NwHIN, is storing a limited amount of information at the national level possibly for population health reasons. This example assumes that all participating state HIEs are structured using the Federated model.

(4.)Private HIE Architecture:-Several hospital systems across the country have created a private HIE system that includes internal databases and referring physicians. Many ACO structures are supported with private HIEs. Most likely a private HIE will utilize the Centralized HIE model since there is a single, private governing organization.

A private HIE is a good way for health systems to create internal interoperability that will allow them to easily connect to HIEs, state databases and, later, the NwHIN.