Health Information Exchange: Navigating and Managing a Network of Health Information Systems

Brian Dixon, Brian Dixon

• Publisher: Academic Press
• Year: 2016
• ISBN:
  9780128031506
• Topic: Medicine
• Subtopic: General Health

Health Information Exchange (HIE): Navigating and Managing a Network of Health Information Systems allows health professionals to appropriately access, and securely share, patients' vital medical information electronically, thus improving the speed, quality, safety, and cost of patient care.

The book presents foundational knowledge on HIE, covering the broad areas of technology, governance, and policy, providing a concise, yet in-depth, look at HIE that can be used as a teaching tool for universities, healthcare organizations with a training component, certification institutions, and as a tool for self-study for independent learners who want to know more about HIE when studying for certification exams.

In addition, it not only provides coverage of the technical, policy, and organizational aspects of HIE, but also touches on HIE as a growing profession. In Part One, the book defines HIE, describing it as an emerging profession within HIT/Informatics. In Part Two, the book provides key information on the policy and governance of HIE, including stakeholder engagement, strategic planning, sustainability, etc. Part Three focuses on the technology behind HIE, defining and describing master person indexes, information infrastructure, interfacing, and messaging, etc. In Part Four, the authors discuss the value of HIE, and how to create and measure it. Finally, in Part Five, the book provides perspectives on the future of HIE, including emerging trends, unresolved challenges, etc.

• Offers foundational knowledge on Health Information Exchange (HIE), covering the broad areas of technology, governance, and policy
• Focuses on explaining HIE and its complexities in the context of U.S. health reform, as well as emerging health IT activities in foreign nations
• Provides a number of in-depth case studies to connect learners to real-world application of the content and lessons from the field
• Offers didactic content organization and an increasing complexity through five parts

Part I

Getting Started with Health Information Exchange

Outline

Chapter 1 What is Health Information Exchange?

Chapter 2 Health Information Exchange as a Profession

Chapter 3 Drivers and Barriers to Adoption

Chapter 1

What is Health Information Exchange?

Brian E. Dixon, Indiana University Richard M. Fairbanks School of Public Health; and the Center for Biomedical Informatics, Regenstrief Institute, Inc., Indianapolis, IN

Abstract

To support health care professionals in managing the array of information available about patients and populations, health systems have adopted a variety of information and communications technologies (ICT). Yet many ICT systems operate as islands unto themselves, unable to connect or share information with other ICT systems. Such fragmentation of data and information is an impediment to achieving the goal of efficient, coordinated health care delivery. Health information exchange (HIE) seeks to address the challenges of connecting disparate ICT systems, enabling information to be available when and where it is needed by clinicians, administrators, and public health authorities. This chapter robustly defines HIE, including its core components, and then describes its evolution within the US health system. This chapter further discusses the rise of HIE in other countries and describes the various forms of HIE found in health systems around the world.

Keywords

Health information exchange; Local Health Information Infrastructure; Health Information Organization; Private HIE; Government-facilitated HIE; Community-based HIE; Vendor-facilitated HIE; transactions; payload; Information and communications technologies (ICT); Electronic Health Record (EHR)

Outline

Introduction 4

Health Information Exchange 5

HIE as a Verb 5

HIE as a Noun 5

Forms of Organized HIE 6

Fundamental Components of HIE 8

Evolution of HIE 11

Models of HIE in the United States 13

Centralized 13

Federated 13

Patient Controlled 14

HIE Outside the United States 15

Purpose and Structure of this Book 16

Summary 17

Questions for Discussion 17

References 17

Learning Objectives

By the end of this chapter, the reader should be able to:

Define the concept of health information exchange (HIE)

Differentiate between the use of HIE as a noun and a verb

Discuss the evolution of HIE and lessons from early HIE efforts

Describe various forms of HIE commonly found in the United States

List and describe the four core components of HIE

Distinguish between HIE forms in the United States and those in other countries

Identify the role that HIE plays in support a nation’s eHealth strategy.

Introduction

Medicine, nursing, pharmacy, dentistry, and allied health professions are information-centric occupations [1,2]. Clinicians must navigate a large corpus of knowledge from the biomedical sciences and an endless stream of new facts, new treatments, and new diagnostic tools. Clinicians must further deal with information from an array of disparate sources, which they must process into decisions and prioritized tasks for the clinical team and patient [3–6]. Nonclinical roles must also review and input information about patients and populations to administer health care processes and organizations.

To support health care professionals in managing the array of information available about patients and populations, health systems have adopted and continue to incorporate a variety of information and communications technologies (ICT) into the delivery and administration of health care. Over the past decade, there has been a significant increase in the adoption and use of health ICT systems in the United States and Canada. National surveys in the US estimate adoption of basic electronic health record (EHR) systems to be near 40%, with adoption rates more than doubling from 2008 to 2012 [7–9]. In Canada, EHR adoption among primary care providers doubled from 23% in 2006 to 56% in 2012 [10]. Growth in adoption has been fueled by both policy, such as the Health Information Technology for Economic and Clinical Health (HITECH) Act [11,12] in the United States; Canadian federal investment in Canada Health Infoway and various provincial e-health initiatives [13]; and the belief that these ICT systems can improve the quality, safety, and efficiency of health services and delivery [14–16]. There is similar growth in adoption and use of ICT in other nations as well [17–19].

Although EHR systems and other forms of health ICT have been demonstrated to be effective at improving health care delivery and outcomes, isolated ICT systems cannot maximize health outcomes because health care delivery occurs within the context of a highly complex system. Patients receive care in a variety of care settings. While there exist a number of health systems that organize (and sometimes manage under an umbrella corporation) primary care, inpatient, laboratory, radiology, and pharmacy services, patients have flexibility in where they receive care. Researchers at the Regenstrief Institute found high levels of patient crossover among emergency departments within and between health system networks [20]. Using data from 96 emergency departments representing over 7.4 million visits and 2.8 million patients over a 3-year period, the researchers found that on average 40% of visits involved patients with data at more than one emergency department. At 15 emergency departments, more than half of their encounters involved patients with data in other health system EHR systems. Similar studies find that providers can only access some of their patients’ information via their EHR system and therefore ICT systems need to be better connected [21,22]. Such fragmentation of information can occur during specific episodes of care, say when a Veteran is discharged from a non-Veterans hospital to a Veterans home, or over the course of the lifetime as patients receive health care for a wide variety of acute and chronic illness.

Because information exists within ICT “silos” managed by various actors within the health system, patients often become the primary method of information transfer between providers [23]. This is undesirable for many reasons, including but not limited inefficiency and the likelihood for error. For example, a recent study that validated parents’ knowledge of their child’s vaccination history found discrepancies in 13% of cases between what parents reported and what was recorded in an immunization information system [24]. To alleviate the burden placed on patients and improve efficiency in accessing information critical to care delivery, health systems establish information exchange between ICT systems. Health information exchange (HIE) enables more complete and timely sharing of data and information among ICT systems used in health care delivery, supporting provider and patient access to information when and where it is needed.

The purpose of this book is to provide a robust description of HIE, its various forms, its use around the world, its governance, and its technical design. Because HIE is critical to the success of health care improvement and reform in the United States and around the world, the book aims to inform those in clinical practice, health care administration and information technology about HIE and its role in supporting health systems. This chapter defines HIE then describes the evolution of it within the US health system. This chapter further discusses the rise of HIE in other countries and describes the various forms of HIE found in health systems around the world. The end of the chapter describes the goals and structure of the book, arming the reader with tools for applying the information to their profession.

Health Information Exchange

HIE is defined as the electronic transfer of clinical and/or administrative information across diverse and often competing health care organizations [25]. In practice, the term HIE is often used both as a verb and a noun.

HIE as a Verb

As a verb, or action word, HIE refers to movement of data or information electronically among stakeholders in the health care sector. The stakeholders are many in size and shape, including doctors’ offices, hospitals, laboratories, payors (eg, insurance companies), pharmacies, urgent care centers, retail-based clinics, home health agencies, long-term postacute care facilities (eg, nursing homes), public health departments, federally qualified health centers, and/or mental health clinics. The information exchanged can range too, from a care plan to a summary of a visit to a laboratory result to a medical history. And while faxes are electronic forms of ICT thus technically HIE, most people tend to conceive of HIE as supporting efforts to move health care organizations away from faxing static, unstructured documents to...