Health information exchange (HIE)-Definition, classification, benefits & challenges

Introduction

Health care providers are increasingly sharing clinical data with other providers who care for the same patient by using electronic health information exchange
(HIE). This development has been driven by the belief that information exchange will address the current fragmentation of patient care across providers, thereby improving care, enhancing patient satisfaction, and making care more efficient by reducing the use of redundant health care services.The health information exchange (HIE) landscape has changed dramatically since HIE and the Nationwide Health Information Network (NwHIN) was first conceptualized in 2001.

What is Health information exchange (HIE)?

Health information exchange (HIE) is the process of utilizing and mobilizing health care information digitally across a community, organizations, the health care sector, and public health.
HIE provides the ability to move the electronic clinical information to the different health care information systems and provides safer, efficient, equitable, and
timelier patient care. Patient safety is one of the important components of health information exchange and plays a crucial role in delivering high-quality health care. The use of HIE can be both advantageous and disadvantageous effects on information safety

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.

Classifications of Health information exchange (HIE)

HIE data and information varies depending on the ability of providers participating in the exchange to receive and send information.
There are currently three key forms of health information exchange:

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

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

iii. 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.

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).

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.

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:

i. Providing other providers with their health information
ii. Identifying and correcting wrong or missing health information
iii. Identifying and correcting incorrect billing information
iv. Tracking and monitoring their own health

HIE Benefits

To better track and securely share patients’ complete medical histories, more and more health care providers are participating in health information exchange (HIE). HIE helps facilitate coordinated patient care, reduce duplicative treatments and avoid costly mistakes. This practice is growing among health providers because the need for HIE is clear and the HIE benefits are significant.

HIE benefits include:
i. Provides a vehicle for improving quality and safety of patient care by reducing medication and medical errors
ii. Stimulates consumer education and patients’ involvement in their own health care
Increases efficiency by eliminating unnecessary paperwork
iii. Provides caregivers with clinical decision support tools for more effective care and treatment
iv. Eliminates redundant or unnecessary testing
v. Improves public health reporting and monitoring
vi. Creates a potential loop for feedback between health-related research and actual practice
vii. Facilitates efficient deployment of emerging technology and health care services
Provides the backbone of technical infrastructure for leverage by national and State-level initiatives
viii. Provides a basic level of interoperability among electronic health records (EHRs) maintained by individual physicians and organizations
ix. Reduces health related costs

Secondary health care provider benefits include reduced expenses associated with:
i. the manual printing, scanning and faxing of documents, including paper and ink costs, as well as the maintenance of associated office machinery
ii. the physical mailing of patient charts and records, and phone communication to verify delivery of traditional communications, referrals, and test results
iii. the time and effort involved in recovering missing patient information, including any duplicate tests required to recover such information

Electronic health information systems can help prevent errors by ensuring that everyone involved in a patient’s care—whether in a primary care setting, a specialists’ office or emergency department—has access to the same information. HIE also encourages efficient care by enabling automatic appointment reminders or follow-up instructions to be sent directly to patients, and prescriptions directly to pharmacies. HIE reduces the amount of time patients spend filling out paperwork and briefing their providers on their medical history, allowing more time for discussions about health concerns and treatments. And by saving time for patients and providers along the entire continuum of health care delivery, HIE has the potential to both reduce costs and improve health outcomes.

Below are some of the common challenges associated with HIE.

Insufficiency in Standards
Lack of standards in digital health information exchange can lead to some privacy concerns. Hence, information exchanged digitally must adhere to some standards in order to be used in EHRs.

Lack of Clarity on Requirements and Variations in Rules
Exchanging health information in other states can be difficult owing to the variation in privacy rules. Moreover, providers are finding it difficult to comply with the state laws when exchanging patient’s health information with the provider in other states.

Difficult to Match Patients to Their Health Records
It is difficult to match patients to their health records when exchanging health information. Providers are finding it difficult to match patients with the health records and exchange information, owing to the presence of several patients with the same name, birth year, and living in the same area. Hence, there is a need for an identifier that can match patients with their health records.

Cost of Health Information Exchange
Covering the cost of health information exchange can be difficult as it includes various costs such as purchasing and implementation cost, cost to participate in local or state HIE organization, transaction fees for exchanging information by vendors. Moreover, sometimes additional cost comes up including establishing an interface for health information exchange.

Contains Only Summary Document
Some health information exchange only contains a summary document, that can also be referred to as continuity of care document. Owing to the generic nature of the document, it sometimes misses important information on the patient’s health that may be important to provide the correct treatment.

Patient Consent
Authorization by the patient is one of the biggest challenges in health information exchange, as authorization is important to exchange health data through various technology and healthcare platforms. It may also lead to legal risks if the health information of the patient is shared without the patient’s authorization.

Rising Competition
Competition among health information exchange providers is intense. Organizations are likely to continue to compete for the patient and on sharing information. According to the report from Harvard Business School, sharing health information is the biggest concern among healthcare providers, and it is such that it impeded health information exchange development.

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:

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.
Identify your current privacy and security concerns and gaps in your current standards of care.
Prioritize use cases for HIE within your system, develop appropriate benchmarks, and integrate these into your existing sustainability plan and operational assessments.
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.
Determine appropriate HIE workflows, and identify gaps in existing workflows that HIE can help to fill.
Evaluate the current IT environment, including interface and interoperability gaps, and determine ways for HIE to fill it.
Make the necessary assessments and adjustments for Stage 1 and 2 meaningful use adoption and attestation.
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

In a nutshell, modern healthcare is being driven by information, documents are stored in EHR systems and organized for exchange.

HIE is increasingly becoming the cornerstone of better clinical workflows and patient outcomes and more and more healthcare organizations are paying attention to the several benefits of health information exchange.

Though there are some challenges with the exchange of health information, we as a digital healthcare software development partner strongly believe in the potential it has to offer.

References:
1.Devine, Emily Beth, et al. “Health information exchange use (1990-2015): a systematic review.” eGEMs 5.1 (2017).
2.Vest, Joshua R., and Larry D. Gamm. “Health information exchange: persistent challenges and new strategies.” Journal of the American Medical Informatics Association 17.3 (2010): 288-294.
3.Hersh, William R., et al. “Outcomes from health information exchange: systematic review and future research needs.” JMIR medical informatics 3.4 (2015): e5215.
4.HealthIT.gov