How much time and money do you spend trying to find information about your patients? Are you frustrated by the difficulties in obtaining patient medical records, test results, lab reports, radiology results, and insurance eligibility from organizations across state lines, down the street, or even across the hall? Do you ever order redundant tests simply because you are unable to access the results of tests ordered by another member of the care team?
You are not alone.
A patient’s health information is typically scattered across many different places and is most often stored as a single piece of paper, without a backup copy. Even when this information is stored electronically, there is no guarantee that one computer system will be able to communicate with to another, so the information must be printed and then faxed or mailed to another practice, where the administrative staff will hand-enter the information into the computer system.
But what if searching for a patient’s information was as quick and easy as using Google to find the weather report for your city? What if that search returned information from all the providers and laboratories that the patient has visited, giving you the information you need, when you need it? Would that save you time and money, as well as enable you to provide better care based on accurate and complete information?
The benefits of appropriate sharing of health information among physicians and other authorized participants are nearly universally understood and desired, and we may be closer than you think to achieving the electronic exchange of health information on a large scale.
What Is Health Information Exchange?
Health information exchange (HIE) is a way to move a patient’s health information securely from one member of the care team to another, with patient consent and according to nationally recognized privacy and confidentiality standard procedures.
HIE not only refers to the active movement of health information but can also refer to the organizational governance and structure facilitating the exchange. These organizations (often called regional health information organizations or RHIOs) focus on both the functional and governance structure required to provide the capability to effectively and efficiently move and translate clinical information among the many health information systems that do not communicate with each other. These organizations are typically geographically defined entities that develop and manage the legal and technical requirements for moving health information among providers within the community.
The number of HIE initiatives is rising at a steady pace, and now—collectively—has a coverage area spanning the entirety of the U.S. as well as the U.S. territories of the Virgin Islands, Puerto Rico, and American Samoa.
How Can a HIE Benefit Your Practice?
According to the e-Health Initiative’s sixth annual survey of health information exchanges, “Migrating Toward Meaningful Use: The State of Health Information Exchange,” operational exchanges have positively affected physician practices and helped them increase efficiency without disrupting patient care.1 Users reported better access to test results, fewer hassles in locating information, and a reduction in staff time spent handling lab results, radiology reports, and clerical tasks. Survey respondents reported that practice efficiencies resulted in shorter workdays and an “improved quality of practice life.”
The most common types of data currently exchanged through HIEs include:
- Laboratory;
- Medication;
- Outpatient laboratory results;
- Outpatient episodes;
- Radiology results;
- Emergency department episodes;
- Inpatient diagnoses and procedures;
- Care summaries;
- Inpatient discharge summaries;
- Pathology;
- Dictation/transcription;
- Claims: pharmacy, medical, and/or hospital; and
- Enrollment/eligibility.
HIE organizations throughout the U.S. are now embarking on aggressive exchange initiatives that expand the services offered and are growing both in the number and diversity of exchange participants. In addition to simply facilitating the exchange of data for the population of patient medical history, participating physicians are able to take advantage of active services related to data exchange, including results delivery, electronic prescribing, enrollment or eligibility checking, electronic referral processing, disease or chronic care management, quality improvement reporting for physicians, disease registries, public health surveillance, connectivity to personal health records, and clinical decision support.
HIE and the National Scene
Policy makers understand that health reform goals of higher quality, more affordable care will not be met without broader and deeper penetration of active information exchange across the entire health delivery system.
To further develop HIE organizations and make exchange opportunities available to all providers, the “American Recovery and Reinvestment Act”—working through the “Health Information Technology for Economic and Clinical Health Act” (also called the “HITECH Act”)—seeks to help the U.S. realize large-scale success in the electronic exchange of health information through policy and funding that will support its growth. The “HITECH Act” provides for a certification framework, grants to states to facilitate infrastructure, grants to develop HIT regional extension centers that will encourage effective and efficient use of technology, and support through a Nationwide Health Information Network (NHIN) governance authority. It is expected that these resources—combined with the approximately $48 billion in incentive payments (and penalties) tied to “meaningful use” of electronic health record (EHR) systems (including clinical data exchange)—can create a business imperative for more information exchange.
The Nationwide Health Information Network (NHIN)
To maximize the value of HIE, efforts are currently underway to connect HIE organizations so they can exchange health information. This would basically create a “health Internet” that would allow providers to access a patient’s health information stored anywhere in the U.S.
This NHIN uses supporting technologies, standards, laws, policies, programs, and practices that enable users to communicate and exchange health information in a way that retains its intended meaning. It is built on a core set of capabilities that ensures secure nationwide information exchange as needed for patient care and population health.
These core capabilities include:
- The ability to find and retrieve healthcare information within and between health information exchanges and other organizations;
- The ability to deliver a summarized patient record to support patient care and the patient’s health;
- The ability to support consumer preferences regarding the exchange of his or her information, including the ability to choose not to participate in NHIN;
- The support of secure information exchange;
- The support of a common trust agreement that establishes the obligations and assurances to which all NHIN participants agree;
- The ability to match participants to their data without a national patient identifier; and
- The support of harmonized standards, which have been developed by voluntary consensus standards bodies for exchange of health information among all such entities and networks.2
The NHIN framework is also being explored as a vehicle for other uses, including EHR and emergency responder data exchange, EHR and lab data exchange, medication management, quality, biosurveillance, and consumer empowerment.
The NHIN has achieved several milestones in recent months. With the development of CONNECT—an open-source software that acts as an on-ramp to the information exchange highway—organizations can now use the NHIN to connect to each other and share data.
In February 2009, the CONNECT software gateway was used for the first time when the Social Security Administration began receiving live patient data from MedVirginia through the NHIN. In most cases, NHIN users could get the patient data necessary to adjudicate applications for disability payments through the system in a matter of minutes, compared with six to eight weeks with paperwork.
Stay Tuned
By providing the capability to effectively and efficiently move clinical information among disparate health information systems while maintaining the meaning of the information being exchanged, a HIE is a key element to building a strong foundation for efforts to improve the U.S. healthcare system.
In next month’s “Practice Page,” we will explore opportunities for your practice to embrace the electronic exchange of healthcare information and the importance of engaging patients in the process.
For more information on health information technology in your practice, contact Itara Barnes at [email protected].
References
- eHealth Initiative Releases Results From 2009 Survey on Health Information Exchange. Available at: www.ehealthinitiative.org/ehealth-initiative-releases-results-2009-survey-health-information-exchange.html. Accessed December 10, 2009.
- Department of Health and Human Services. Nationwide Health Information Network. Available at: http://healthit.hhs. gov/portal/server.pt?open=512&objID=1142&parentname=CommunityPage&parentid=1&mode=2&in_hi_userid=10741&cached=true. Accessed December 10, 2009.
