10 things to know about health information exchanges

On the spectrum of slippery health IT terms, 'health information exchange' dwells on the more-difficult-to-define end.

The term can be generally used to describe the concrete 'give and take' of patient health data across electronic platforms or between providers; it can be used in a more conceptual sense to frame the idea of the fluid movement of health data as it changes hands; or 'health information exchanges' may also refer to the organization or entity facilitating the transfer of information.

Here are 10 things to know about health information exchange relative to each of the meanings explained above.

1. "The primary function of an HIE is to permit access to clinical information on demand at the point of care," according to an American Health Information Management Association report. "A successful HIE depends on trust between the patient, the healthcare provider and the HIE. In order to build trust, HIEs must develop and implement policies and procedures guiding their operations, including how they will maintain and secure protected health information."

2. Currently, the ONC recognizes three types of health information exchange.

• Directed Exchange. The ability to send and receive secure information electronically between care providers to support coordinated care.
• Query-based Exchange. The ability for providers to find and/or request information on a patient from other providers, often used for unplanned care.
• Consumer Mediated Exchange. The ability for patients to aggregate and control the use of their health information among providers.

3. In March 2010, as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, the ONC awarded funds to 56 states, territories and qualified State Designated Entities as part of the State Health Information Exchange Cooperative Agreement Program. States and state designated HIE entities received nearly $548 million through this program, which funds states' efforts to rapidly build capacity for exchanging health information across the healthcare system both within and across states, according the ONC. Awardees are responsible for increasing connectivity and enabling patient-centric information flow to improve the quality and efficiency of care.

4. In January 2011, another $16.3 million was made available to states through the ONC's Challenge Grants program, which provides funding to states to encourage breakthrough innovations for health information exchange that can be leveraged nationwide to support interoperability.

5. In April 2011, the National Governors Association published its State and Federal Consent Laws Affecting Interstate Health Information Exchange Report in an attempt to address HIE privacy and consent issues arising from a lack of guidelines and standards for HIEs. In the report, the NGA reviewed existing literature and a series of nine 'health information organization' case studies to outline best practices for these entities in regard to patient consent of health record-sharing and exchange.

6. Between January and May 2014, the ONC and University of Chicago's National Opinion research center conducted site visits and discussion-based check-ins with providers across six states to determine their experience with HIEs. In June 2015, the NORC and ONC released their report, Provider Experiences with HIE: Key Findings from a Six State Review. The researchers also sought input from vendors to gain accurate perspectives on state-level HIE programs and the quality and efficiency of electronic information exchange overall. Here are some of the takeaways providers offered to the researchers in their discussions of HIE experiences, according to HIMSS.

• To meaningfully improve patient care through the use of HIE, there must be a focus on interoperability at the vendor level.
• Due to a greater emphasis on affordable care organizations and patient-centered medical homes, there is a need to include providers ineligible for meaningful use within the interoperability framework.
• Providers in most states believed state HIE programs contributed to awareness around HIE and the benefits of exchanging information.
• Providers conveyed a general sentiment that a state-based HIE effort is important and can bring stakeholders together.

7. Some states, most recently Texas, have approved legislation that encourages HIE. Texas House Bill 2641, signed into law on June 19, aims to better define health information exchange within state statute and ensures all public systems are able to exchange patient health data securely and in accordance with national standards. It also allows health-related information to be transmitted through local HIEs to the appropriate state public health agencies, an important provision for developers working to facilitate the secure exchange of health data.

8. The Status of Health Information Exchanges: 50 State Comparison is a project of George Washington University's Hirsh Health Law and Policy Program in Washington and the Robert Wood Johnson Foundation in Princeton, N.J. Its website features an interactive map of the U.S., color-coded to reflect the types of health information exchanges state-by-state. It uses the following designations to categorize the types of HIEs implemented in each state.

• HIE is a joint effort of a previously existing state agency and a newly created organization
• State government directly runs the HIE via an existing agency
• An organization is created to manage and operate the HIE
• State government contracts HIE capabilities to an existing health information organization
• No recent information on operating structure available

All states and territories except Idaho, Nebraska, Washington, D.C., and Connecticut have dedicated HIE systems of their own.

9. A study conducted by the American Medical Informatics Association found states with stronger privacy laws that limit the disclosure of health information had significantly more HIEs exchanging data and fewer failed HIEs. They attribute this counterintuitive conclusion to the subtle benefits of having such laws in place, such as increased confidence and trust among participants in an exchange.

10. In a September 2014 letter to HHS, representatives from HIMSS included the necessity for an interoperable platform for health information exchanges as one of three key policy levers to focus on in accordance with the meaningful use participation timeline . Building and maintaining an interoperability framework for HIEs would enable providers and patients to secure access of the right information at the right time, they wrote.

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