This article is designed to give a basic overview of HIE (health information exchange), and explain what an HIE is and what it can mean to public health personnel.
While HIE is a somewhat common term among public health personnel and many health workers are well-informed, others may be stepping into the world of HIE for the first time or may wish for a better understanding of the subject.
HIE software
An HIE is the software (and company that builds and maintains the software) that enables the exchange of health information using industry accepted standards.
- Some HIEs are run by private companies and some are run by state government
- Some HIEs are set up to exchange health information to participants across the state and others can exchange data across several states
- Some states even have multiple HIEs within the state
An HIE is a way for different care givers to share clinical information electronically while maintaining HIPAA compliance.
In very simple terms, it’s how County A could electronically request a client’s health information and securely receive it from County B, when they need it.
An HIE allows providers to exchange this data in a way that both parties will understand, so that the data is meaningful to both the sender and the receiver.
HIE solutions
Health information exchange (HIE) has been promoted to improve the efficiency, cost-effectiveness, quality, and safety of health care delivery. This chapter describes the evidence base to support that assertion, describing a systematic review of the effectiveness, use, usability, implementation, and sustainability of HIE. The review identified 136 studies; 34 on effectiveness, 58 on the use of HIE, 22 on usability and facilitators and barriers to use of HIE, 45 on facilitators or barriers to HIE implementation, and 17 on factors related to sustainability.
No studies reported on clinical outcomes (eg, mortality and morbidity) or identified harms. Low-quality evidence generally finds that HIE reduces duplicative laboratory and radiology testing, emergency department costs, hospital admissions (less so for readmissions), and improves public health reporting, ambulatory quality of care, and disability claims processing. Most clinicians attributed positive changes in care coordination, communication, and knowledge about patients to HIE.
The use of HIE has increased over time, but within organizations the number of users or HIE-accessed visits was generally low. Barriers to HIE use were lack of critical mass of data, inefficient workflow, and poorly designed interface as well as update features. Greater usability was associated with greater use but not with effectiveness.
Facilitators of HIE implementation were characteristics of the organization (eg, leadership) or the HIE system, while barriers included competition or lack of a business case for HIE. Although the evidence supports a benefit of HIE in reducing the use of specific resources and may improve quality of care, the full impact of HIE on clinical outcomes and potential harms is inadequately studied. Future studies should address comprehensive questions, use more rigorous designs, and employ a standard for describing types of HIE.
Health information exchange software
According to The Office of the National Coordinator for Health Information Technology2, HIE systems allow healthcare professionals—and patients—to freely and securely exchange a patient’s medical record electronically. As patients age and develop increasingly complex medical needs, their information must move with them throughout the healthcare system. But traditional methods of sharing information, such as telephone calls, faxes, and postal mail, are all subject to error.
HIE incorporates patient data from multiple entities into one convenient system, which has been shown to help make informed treatment decisions at the point of care while also reducing readmissions, medication errors, and duplicate testing.1 Currently, there are three forms of HIE:
Health information exchange solutions
November 29, 2016 – “Hospitals and physicians are now exchanging more electronic health information than ever before,” the Office of the National Coordinator for Health Information Technology told Congress in an annual report from early November.
“In 2008, 41 percent of all hospitals electronically exchanged health information with outside health care providers,” the report continues. “These rates have since doubled. In 2015, more than eight in ten (82 percent) non-federal acute care hospitals electronically exchanged laboratory results, radiology reports, clinical summaries or medication lists.”
“Moreover, of the hospitals that electronically send, receive, find, and integrate information, approximately nine out of ten report that they routinely had clinical information needed from outside sources or health care providers available at the point of care, which is about double the national average,” it states.
According to ONC, an increased flow of health information is happening. However, these statistics paint an incomplete and rather complicated picture of health information exchange across the country and beg a few questions to be asked.
HIE software solutions
HIE as we have defined it necessitates electronic transfer between ICT systems. Therefore ICT systems need technical methods for facilitating exchange of information. In ICT speak, there must be a sender and a receiver. For example, a laboratory information system (LIS) sends lab test results to an EHR system to record the results in a patient’s records.
Yet an LIS can also receive an order to perform a lab test from an EHR system. These electronic transactions provide the technical foundation for HIE. Almost any ICT system in health care can be either a sender or a receiver depending on the scenario. Therefore the potential configuration of technical networks involving ICT is many. Regardless of which ICT systems are involved in HIE or the direction in which information flows, there will be senders and receivers. Several chapters in the book describe in greater detail the technologies that support sending and receiving health information among networks of ICT systems.
Information exchange software
The IHE specifications are implemented by Health Information Exchange (HIE) software, in order to administer the sharing of documents among healthcare enterprises such as clinics, private physicians and public health and research facilities. HIE operates on a flexible architecture that is capable of handling a variety of requirements, since the registry stores metadata containing location information of databases that can be centralized or distributed (IBM 3).
It is important to protect the patient’s health information when developing systems and structures that support the exchange of that information using the HIEs. The HIE is expected to maintain a “trusting and supportive relationship with the organizations that provide data to, and retrieve data from, one another through the HIE” (Scholl, Stine and Lin 7). The development of electronic health records (EHRs) like HealthTECHResourcesInc.com and improvement of the US healthcare system requires secure exchange of electronic health information. A systematic approach is therefore important for successful and secure implementation of HIE.
The security architecture design involves: capstone policies, which are developed by an organization that incorporates all requirements and guidance for protecting health information within HIEs; enabling services or services necessary to execute the policies; enabling processes that control the operations; notional architectures used as blue prints to drive the selection of technical solutions and data standards; and technology solutions and standards, which are necessary to implement the notional architecture .
Considerable obstructions to interoperable systems can arise due to the evolving standards by inducing maintenance in every vendor product, causing the consumers to decide between innovation and interoperability. The open source community, such as Open Health Tools, has the ability to share the cost of maintaining evolving standards. Open Health Tools includes: the US Veterans Administration, Canada Health Infoway, HL7, ITSDO, and IBM among others, and their role is to expedite the adoption of healthcare informatics technology
HIE healthcare information exchange
Es) are local standardized data repositories through which hospitals,health care providers, and pharmacists can electronically document, track, and share patient health data.They are a convenient means to ensure key medical data such as admissions, discharges, and informationassociated with a visit is complete, current, and easily accessible. HIEs also improve the speed, quality,safety, and cost of patient care (HealthcareIT.gov).
In addition to supporting patient care, HIEs can enable high performance on two new Centers forMedicare & Medicaid Services (CMS) Star Rating measures. Both measures require timelycommunication about patient admission and discharge so that documentation and outreach occur within the designated timeframe. The new measures are:
• Transitions of care, which requires documentation of inpatient admission to the hospital, discharge from the hospital, patient engagement post-discharge, and medication reconciliation.
• Follow-up after emergency department (ED) visit for people with multiple high-risk chronic conditions, which requires follow-up services within seven days of discharge.