Health information exchange

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Health information exchange (HIE) is the mobilization of health care information electronically across organizations within a region, community or hospital system. Participants in data exchange are called in the aggregate Health Information Networks (HIN). In practice, the term HIE may also refer to the health information organization (HIO) that facilitates the exchange.

Contents

The goal of HIE is to facilitate access to and retrieval of clinical data to provide to public health authorities in analyses of the health of the population.

Formal organizations support financial statewide health information exchange grants from the Office of the National Coordinator for Health Information Technology. These grants were legislated into the HITECH components of the American Recovery and Reinvestment Act of 2009. [1] The Regional Health Information Organizations, or RHIOs, are ordinarily geographically defined entities which develop and manage a set of contractual conventions and terms, arrange for the means of electronic exchange of information, and develop and maintain HIE standards. [2]

In the United States, federal and state regulations regarding HIEs and health information technology (HIT) are still being defined. Federal regulations and incentive programs such as "Meaningful Use", which is formally known as the EHR Incentive Program, [3] [4] are changing. The vast majority of HIEs and RHIOs remain tied to federal, state, or independent grant funding in order to remain operational. Some exceptions exist, such as the Indiana HIE. [5] [6]

Storage and gathering of information

Data architecture models

In a centralized model of HIE, there is a central (or master) database that holds a copy of all of the records of every patient contained. In a federated model of HIE, there is no master database.

In a centralized model, patient information is uploaded to a single database from which any provider in the HIE can download. In a federated model, records are exchanged electronically among providers when they need them. [7] [8]

Exchanges in the US must operate with patient consent to comply with not only the Health Insurance Portability and Accountability Act (HIPAA) and also variety of state and federal laws and regulations. This was clarified by the Office of Civil Rights in the January 2013 Final Omnibus Rule Update to HIPAA. [9]

There are two methods for gaining patient consent. One is explicit consent and is termed opt-in. With this method, a patient is not automatically enrolled into the HIE by default and generally must submit a written request to join the exchange.

The other method is implicit patient consent and is termed opt-out. In this method, patients give implicit consent to join an HIE when they agree to use the services of a health care provider who is submitting data into an HIE and sign the provider's Notice Of Privacy Practices. Patients can request to opt out of the HIE, generally with a written form. [10]

Notable European health information exchanges

Netherlands

Frysian Health Information Exchange
Connects Medical Centre Leeuwarden and Academic Center in Groningen with community hospitals like Nij Smellinghe Hospital in Drachten. [11] [12]
The Friesland Regional Cardiology Network reduces the length-of-stay for patients in hospitals by one or two days. [12] Once the records were uploaded to the cardiology network, records remain available for consultation at any time so that previous episodes of a patient's care can be consulted.

North of the Netherlands – XDS Network

Hospitals in the Dutch provinces Groningen, Friesland and Drenthe have created an (diagnostic) image exchange network in order to phase out CD/DVD based exchanges using an IHE (XDS) platform. St. Gerrit, the local HIE organization, has gradually expanded the network since 2014, spanning 10 hospitals to date.

Other

United Kingdom

Ireland

Finland

Notable United States health information exchanges

Individual exchanges

Chesapeake Regional Information System for our Patients
CRISP is a non-profit corporation that is implementing health information exchange in the state of Maryland. The organization also serves as the Health IT Extension Center for Maryland. CRISP was created by Johns Hopkins Medicine, MedStar Health, the University of Maryland Medical System and Erickson Retirement Communities. [19] Audacious Inquiry, a health information system consulting firm, serves as the technical architect and strategic partner for the health information exchange while Dynamed Solutions provides operational, project management and organizational support under CRISP.
Health Current
Health Current, formerly Arizona Health-e Connection (AzHeC), is the health information exchange (HIE) that shares information across Arizona. [20] Health Current grew out of a gubernatorial executive order in 2007. [21]
Delaware Health Information Network
Delaware Health Information Network (DHIN) is a non-profit public-private partnership enacted by the Delaware General Assembly in 1997. DHIN has adopted regulations to govern its operations and has policies and procedures. DHIN started in May 2007. In February 2012, The Delaware Health Information Network announced full participation of all acute care hospitals and skilled nursing facilities in the state, along with the vast majority of Delaware providers, in the first statewide community health record. As of June 2013, DHIN has the participation of 97 percent of Delaware providers, tracks around 88 percent of Delaware's population, and delivers more than 10 million clinical results and reports to participating providers annually. [22]
Idaho Health Data Exchange
The Idaho Health Data Exchange (IHDE) is the state designated Health Information Exchange (HIE) for Idaho. Health Information Exchange enables doctors, nurses, labs, and other medical providers to securely access their patient's electronic health information quickly, 24/7/365. IHDE is a non-profit 501(c)(6) company. Located in Boise, Idaho, the staff consists of an Executive Director, Executive Assistant, Sr. Marketing Coordinator, Business Analysts (Implementations), Training/Support Specialists, and IT systems support. Members of the Board of Directors and Privacy and Security Committee represent the private and public sectors, and delivery systems. [23]
Indiana Health Information Exchange
The Indiana Health Information Exchange (IHIE) operates the U.S.' largest HIE and one of the oldest with data on more than 7 million patients. Created by the Regenstrief Institute, a medical informatics think tank, the Indiana Network for Patient Care (INPC) is a secure network that provides patient records to participating doctors. This HIE grew from 12 hospitals in the center of the state with approximately 5,000 physicians, to 106 hospitals out of 126 in the state and more than 14,000 physicians in Indiana. [24]
Ohio Health Information Partnership
The Ohio Health Information Partnership (with CliniSync; HIE) is a nonprofit, public/private partnership initially funded with $14.8 million in federal HITECH funds under the Office of the National Coordinator for HIT. It is the state-designated statewide health information exchange founded by the Ohio State Medical Association, the Ohio Osteopathic Association, the Ohio Hospital Association, BioOhio and the Ohio Department of Insurance.[ citation needed ] CliniSync is an independent nonprofit founded in 2009. [25] It received $43.8 million in HITECH funding. [25]
Federal funds paid for the creation of the technological infrastructure, powered by Medicity, as well as discounted implementation fees for hospitals in Ohio.[ citation needed ]As of 2016, CliniSync has 148 hospitals contracted, with 123 "live," and over 400 long-term and post-acute care facilities. [25]
In 2015, CliniSync enabled practices and other authorized users to look up and find (query and retrieve) a longitudinal Community Health Record on a patient.
CliniSync members will receive notifications when a patient is discharged or admitted to the hospital or Emergency Department in late 2016.

See also

Related Research Articles

<span class="mw-page-title-main">Health Insurance Portability and Accountability Act</span> United States federal law concerning health information

The Health Insurance Portability and Accountability Act of 1996 is a United States Act of Congress enacted by the 104th United States Congress and signed into law by President Bill Clinton on August 21, 1996. It modernized the flow of healthcare information, stipulated how personally identifiable information maintained by the healthcare and healthcare insurance industries should be protected from fraud and theft, and addressed some limitations on healthcare insurance coverage. It generally prohibits healthcare providers and healthcare businesses, called covered entities, from disclosing protected information to anyone other than a patient and the patient's authorized representatives without their consent. With limited exceptions, it does not restrict patients from receiving information about themselves. It does not prohibit patients from voluntarily sharing their health information however they choose, nor does it require confidentiality where a patient discloses medical information to family members, friends, or other individuals not a part of a covered entity.

The Healthcare Information and Management Systems Society (HIMSS) is an American not-for-profit organization dedicated to improving health care in quality, safety, cost-effectiveness and access through the best use of information technology and management systems. It was founded in 1961 as the Hospital Management Systems Society. It is now headquartered in Chicago, Illinois. The society has more than 100,000 individuals, 480 provider organizations, 470 non-profit partners and 650 health services organizations. HIMSS is a US 501(c)6 organization.

A personal health record (PHR) is a health record where health data and other information related to the care of a patient is maintained by the patient. This stands in contrast to the more widely used electronic medical record, which is operated by institutions and contains data entered by clinicians to support insurance claims. The intention of a PHR is to provide a complete and accurate summary of an individual's medical history which is accessible online. The health data on a PHR might include patient-reported outcome data, lab results, and data from devices such as wireless electronic weighing scales or from a smartphone.

Health technology is defined by the World Health Organization as the "application of organized knowledge and skills in the form of devices, medicines, vaccines, procedures, and systems developed to solve a health problem and improve quality of lives". This includes pharmaceuticals, devices, procedures, and organizational systems used in the healthcare industry, as well as computer-supported information systems. In the United States, these technologies involve standardized physical objects, as well as traditional and designed social means and methods to treat or care for patients.

A Regional Health Information Organization, also called a Health Information Exchange Organization, is a multistakeholder organization created to facilitate a health information exchange (HIE) – the transfer of healthcare information electronically across organizations – among stakeholders of that region's healthcare system. The ultimate objective is to improve the safety, quality, and efficiency of healthcare as well as access to healthcare through the efficient application of health information technology. RHIOs are also intended to support secondary use of clinical data for research as well as institution/provider quality assessment and improvement. RHIO stakeholders include smaller clinics, hospitals, medical societies, major employers and payers.

The eHealth Exchange, formerly known as the Nationwide Health Information Network, is an initiative for the exchange of healthcare information. It was developed under the auspices of the U.S. Office of the National Coordinator for Health Information Technology (ONC), and now managed by a non-profit industry coalition called Sequoia Project. The exchange is a web-services based series of specifications designed to securely exchange healthcare related data. The NwHIN is related to the Direct Project which uses a secure email-based approach. One of the latest goals is to increase the amount of onboarding information about the NwHIN to prospective vendors of health care systems.

Patient portals are healthcare-related online applications that allow patients to interact and communicate with their healthcare providers, such as physicians and hospitals. Typically, portal services are available on the Internet at all hours of the day and night. Some patient portal applications exist as stand-alone web sites and sell their services to healthcare providers. Other portal applications are integrated into the existing web site of a healthcare provider. Still others are modules added onto an existing electronic medical record (EMR) system. What all of these services share is the ability of patients to interact with their medical information via the Internet. Currently, the lines between an EMR, a personal health record, and a patient portal are blurring. For example, Intuit Health and Microsoft HealthVault describe themselves as personal health records (PHRs), but they can interface with EMRs and communicate through the Continuity of Care Record standard, displaying patient data on the Internet so it can be viewed through a patient portal.

Health information technology (HIT) is health technology, particularly information technology, applied to health and health care. It supports health information management across computerized systems and the secure exchange of health information between consumers, providers, payers, and quality monitors. Based on a 2008 report on a small series of studies conducted at four sites that provide ambulatory care – three U.S. medical centers and one in the Netherlands, the use of electronic health records (EHRs) was viewed as the most promising tool for improving the overall quality, safety and efficiency of the health delivery system.

The Office of the National Coordinator for Health Information Technology (ONC) is a staff division of the Office of the Secretary, within the U.S. Department of Health and Human Services. ONC leads national health IT efforts, charged as the principal federal entity to coordinate nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information.

Consent management is a system, process or set of policies for allowing consumers and patients to determine what health information they are willing to permit their various care providers to access. It enables patients and consumers to affirm their participation in e-health initiatives and to establish consent directives to determine who will have access to their protected health information (PHI), for what purpose and under what circumstances. Consent management supports the dynamic creation, management and enforcement of consumer, organizational and jurisdictional privacy policies.

<span class="mw-page-title-main">VistA</span> Health information system

The Veterans Health Information Systems and Technology Architecture (VISTA) is the system of record for the clinical, administrative and financial operations of the Veterans Health Administration VISTA consists of over 180 clinical, financial, and administrative applications integrated within a single shared lifelong database (figure 1).

The Chesapeake Regional Information System for our Patients (CRISP) is a nonprofit organization created to function as Maryland's state-designated health information exchange (HIE), by the Maryland Health Care Commission. CRISP currently serves as the HIE for Maryland and the District of Columbia. CRISP is advised by a wide range of stakeholders who are responsible for healthcare throughout the region.

Informatics Corporation of America (ICA) is a privately held health information technology organization headquartered in Nashville, Tennessee. It serves integrated delivery systems (IDNs), health information exchanges (HIEs), individual hospitals, Independent Practice Associations (IPAs), and Regional Health Information Systems (RHIOs). In 2000, some of Vanderbilt University Medical Center's (VUMC) practicing physicians teamed up with informatics professionals to develop two complementary software applications—dubbed StarChart and StarPanel—to aggregate and organise medical data, and to improve communication and clinical decision-making within a single interface. This technology has allowed VUMC to improve efficiency and communication processes in order to deliver cohesive care across the medical center and its affiliated clinics and physicians' practices.

The Electronic Healthcare Network Accreditation Commission (EHNAC) is a voluntary, self-governing standards development organization (SDO) in the United States established to develop standard criteria and accredit organizations that electronically exchange healthcare data. These entities include electronic health networks, payers, financial services firms, health information exchanges (HIEs), management service organizations and e-prescribing solution providers.

The Health Information Technology for Economic and Clinical Health Act, abbreviated the HITECH Act, was enacted under Title XIII of the American Recovery and Reinvestment Act of 2009. Under the HITECH Act, the United States Department of Health and Human Services resolved to spend $25.9 billion to promote and expand the adoption of health information technology. The Washington Post reported the inclusion of "as much as $36.5 billion in spending to create a nationwide network of electronic health records." At the time it was enacted, it was considered "the most important piece of health care legislation to be passed in the last 20 to 30 years" and the "foundation for health care reform."

Healthcare CRM, also known as Healthcare Relationship Management, is a broadly used term for a Customer relationship management system, or CRM, used in healthcare.

<span class="mw-page-title-main">Medical image sharing</span> Electronic exchange of medical images

Medical image sharing is the electronic exchange of medical images between hospitals, physicians and patients. Rather than using traditional media, such as a CD or DVD, and either shipping it out or having patients carry it with them, technology now allows for the sharing of these images using the cloud. The primary format for images is DICOM. Typically, non-image data such as reports may be attached in standard formats like PDF during the sending process. Additionally, there are standards in the industry, such as IHE Cross Enterprise Document Sharing for Imaging (XDS-I), for managing the sharing of documents between healthcare enterprises. A typical architecture involved in setup is a locally installed server, which sits behind the firewall, allowing secure transmissions with outside facilities. In 2009, the Radiological Society of North America launched the "Image Share" project, with the goal of giving patients control of their imaging histories by allowing them to manage these records as they would online banking or shopping.

InterSystems HealthShare is a healthcare informatics platform for hospitals, integrated delivery networks (IDNs) and regional and national health information exchanges (HIE).

HealthShare Exchange (HSX) is a membership-dues-supported nonprofit health information exchange formed in 2009 and incorporated in 2012 by Greater Philadelphia's hospitals, health systems, and healthcare insurers.[1][2] It links the electronic medical record (EMR) systems of different hospital health systems and other healthcare providers — and the claims data of healthcare insurers — to make this information accessible at inpatient and outpatient points of care (including medical practice offices) and for care management. HSX services provide recent clinical care information, and alert providers and health plans to care events.[2] Health information exchange makes patient care more informed and coordinated, and reduces unnecessary care and readmissions. HSX serves the greater Delaware Valley region, including southeastern Pennsylvania and southern New Jersey.[2]

HIE of One is a free software project developing tools for patients to manage their own health records. HIE stands for Health Information Exchange, an electronic network for sharing health information across different organizations, hospitals, providers, and patients. This is one of a growing number of tools for encrypted data exchange within the healthcare sphere.

References

  1. ↑ "State Health Information Exchange Cooperative Agreement Program". The Office of the National Coordinator for Health Information Technology. U.S. Department of Health & Human Services. 27 January 2011. Archived from the original on February 9, 2011. Retrieved December 23, 2010.
  2. ↑ Overhage JM, Evans L, Marchibroda J (2005). "Communities' readiness for health information exchange: the National Landscape in 2004". J Am Med Inform Assoc. 12 (2): 107–12. doi:10.1197/jamia.M1680. PMC   551542 . PMID   15561785.
  3. ↑ "Electronic Health Records (EHR) Incentive Programs". Centers for Medicare & Medicaid Services.
  4. ↑ "Meaningful Use". Health Information Technology. U.S. Department of Health & Human Services. 16 March 2010. Archived from the original on April 20, 2010. Retrieved April 21, 2010.
  5. ↑ "Home". Indiana Health Information Exchange. Retrieved 13 April 2016.
  6. ↑ McGee, Marianne (7 June 2012). "8 Health Information Exchanges Lead The Way". Information Week. UBM. Archived from the original on 25 April 2016. Retrieved 10 June 2012.{{cite web}}: CS1 maint: bot: original URL status unknown (link)
  7. ↑ HIMSS HIE Guide Work Group (November 2009). "Topic Series: HIE Technical Models" (PDF). Healthcare Information and Management Systems Society (HIMSS). Archived from the original (PDF) on 2014-03-19.
  8. ↑ "HIMSS RHIO / HIE". HIMSS. Healthcare Information and Management Systems Society. Archived from the original on 2008-09-26.
  9. ↑ "The Health Insurance Portability and Accountability Act (HIPAA) Omnibus Final Rule Summary" (PDF). American Medical Association. 19 February 2013. Archived from the original (PDF) on 2013-04-18.
  10. ↑ "Opt-in Versus Opt-out: Consent Models for Health Information Exchange through Missouri's Statewide Health Information Exchange Network" (PDF). Missouri Department of Social Services. 14 April 2010. Archived from the original (PDF) on 2010-05-27.
  11. ↑ "Project References". Forcare. Forcare Canada Inc. Archived from the original on 20 September 2016. Retrieved 15 September 2016.
  12. 1 2 Brosky, John (21 May 2010). "Dutch cardiology network enables real-time consultations". healthcare-in-europe.com. European Hospital. Retrieved 15 September 2016.
  13. ↑ "Home". ZorgNetOost (in Dutch). Retrieved 27 September 2017.
  14. ↑ "Stichting Regionaal Elektronisch Netwerk West-Brabant" (in Dutch). Retrieved 27 September 2017.
  15. ↑ "Newsletter" (PDF). ihe-nl.org. 2015. Retrieved 2019-05-21.
  16. ↑ "Newsletter" (PDF). ihe-nl.org. Retrieved 2019-05-21.
  17. ↑ "Trijn" (in Dutch). Retrieved 27 September 2017.
  18. ↑ "Stichting Zorgring NHN" (in Dutch). Retrieved 27 September 2017.
  19. ↑ Sentementes, Gus G. (2021). "Basic Tools For Most Common Health Issues". Health Care in USA. Archived from the original on January 8, 2022. Retrieved 2009-11-26.
  20. ↑ "Health Current Home Page". Archived from the original on 2018-01-10. Retrieved 2018-01-09.
  21. ↑ "About Us".
  22. ↑ "Statewide Health Information Exchange Generates High Levels of Participation and Many Reports of Improved Quality and Efficiency". Agency for Healthcare Research and Quality. 2013-06-05. Retrieved 2013-06-06.
  23. ↑ IHDE (2014). "IHDE".
  24. ↑ "Trends in Health Information Exchanges: A Conversation With J. Marc Overhage, MD, PhD, Chief Medical Informatics Officer at Siemens Healthcare, Health Services". Agency for Healthcare Research and Quality. 2013-06-05. Retrieved 2013-06-06.
  25. 1 2 3 "Our Approach". CliniSync. Retrieved 15 September 2016.

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