What is Health Information Exchange?
Health Information Exchange (HIE) is the electronic transfer of medical information between patients and various healthcare professionals such as: nurses, physicians and pharmacists.
Despite the far-reaching accessibility of HIE as a safe way to transfer medical data, as of 2014, paper records are still the dominating source of Americans’ medical records storage. Though the value of doctor-patient communication is irreplaceable, the comprehensiveness of the patient’s health records can be significantly improved by HIE .
HIEs are available in three different forms: directed exchange, query-based exchange and consumer mediated exchange. Directed exchange allows the secure transfer of medical information back and forth between providers. An example of directed exchange would be when a specialist receives a patient’s medical summary and test results from a primary care provider .
Query-based exchange allows physicians to locate and to ask for a patient’s information from other providers and is usually used for emergency care. For example, if a patient needs to visit an emergency room for immediate treatment, query-based exchange allows the emergency room doctor to access the patient’s information from their regular clinic/provider. It is important for the doctors in such situations because it allows them to formulate better treatment plans and to look for potential medication reactions and/or previous test results .
Consumer mediated exchange allows the patients to collect and regulate the use of their medical records between providers. By having access to their medical records, patients have better management and coordination of both their information and health care .
Why is HIE important?
HIEs are important to the healthcare industry for many reasons and the advantages to using HIE are substantial. HIEs can improve/benefit the health care industry in the following ways:
- It is a secure way to electronically share medical information which, in turn, improves patient care because the safety, speed and quality of data transfer increase and costs are lowered 
- It offers care providers more complete patient records 
- It allows care providers to have quick access to their patients’ information and thus generates more informed decisions. As a result, providers give better diagnoses, evade readmissions and lower medication errors 
- HIEs lead to data standardization so the patient’s health information can easily incorporate into their Electronic Health Record (EHR) 
- Providers can access a patient’s health history in case of an emergency if the patient is unable to give a history 
- Data is kept safe in disasters such as floods and fires 
- HIEs allow data to be tracked and thus makes is easier to regulate access to EHRs 
- HIEs help patients be involved in their care 
- It minimizes paperwork and improves efficiency 
- It is a better system for public health recording/monitoring 
Although the benefits are vast, there still are some downfalls associated with HIE. The risks involved with using HIEs are as follows:
- Increased potential for medical identity theft 
- Any inaccuracies the provider enters into the EHR stay in the record unless/until it gets fixed 
- Patient consent can be a challenge and can lead to potential lawsuits if authorization is not given before the HIE occurs 
Barriers facing HIE
While the implementation of HIEs is notable and its benefits are great, it is not a completely perfected tool and it faces a number of barriers. The first obstacle is that there is a lot of competition among HIE vendors. Currently, there are 12 main vendors and HIEs need to choose the best and most experienced one. Choosing a vendor can be problematic because HIEs are sometimes forced to have multiple vendors since the original vendor may not be as experienced in a new form of HIE .
Another barrier that HIEs are challenged with is the lack established federal standards and hospital resources such as staff and/or technology. The absence of IT resources and unsolidified standards forces integration to take longer and cost more. Consequently, the implementation of HIE projects are hindered because they are outsourced to several organizations instead of being the main focus of the chief shareholder’s interest .
The last challenge is that mergers and acquisitions between health care organizations frequently lead to multiple systems being operated between HIEs and Accountable Care Organizations (ACOs). The use of multiple systems leads to a lack of communication and therefore, higher costs to the organization and patients .
What do ACOs have to do with HIEs and why are they relevant?
ACOs are groups of care providers (clinics, hospitals, etc.) who join together and coordinate their care. The goal of an ACO is to make sure the patients receive the correct care, in a timely manner and with minimal errors and/or duplicated tests. ACOs and HIEs are interconnected because they work together to ensure better patient care and treatment .
Since ACOs work by paying health care providers based on their ability to give quality, coordinated care rather than using a fee-for-service payment model, HIEs are an essential part of making the ACO work. By using HIEs, giving and receiving referrals from providers and hospitals is quicker and easier than if HIEs were not used to transport data. The immediate transfer of data allows ACOs to have the necessary information to distribute amongst the team .
Without the use of HIEs, ACOs would fail to succeed because they depend on having quick, secure and accurate medical records in order to properly coordinate the patient’s care. Health care organizations cannot make the conversion to an ACO without the implementation of HIE due to the irreplaceable need to have full access to medical records .
Solutions to barriers facing HIE
Although the benefits of HIEs are significant, there is still work to be done to improve its application. Several solutions are available to help break down the barriers that HIEs face. The first solution is that health care providers must be willing to develop alternative plans for unexpected challenges during the implementation process . For example, if a hospital originally chooses to use a vendor that specializes in directed exchange and they decide to add technology that allows their patients access to their medical records, they need to make sure that the original vendor is experienced in both directed exchange and consumer mediated exchange. If not, the hospital must be ready and willing to switch vendors .
The next solution is that both hospitals and clinics must make HIE utilization a priority. In order to prioritize the successful application of HIEs, the health care organization must secure and distribute necessary resources to its staff. In addition to resources, it is imperative that there is ample communication between the health care organization and the HIE vendor . By prioritizing the employment of HIE, allocating the required resources and encouraging plenty of dialog between the HIE vendor(s) and hospital/clinic, the value of HIEs will be showcased and will ultimately lead to better, faster integration .
The final way HIEs can be improved is to encourage organizations to work together towards standardization to improve interoperability. Since the lack of interoperability is a significant barrier that HIEs face, the Office of the Nation Coordinator for Health Information Technology (ONC) has pledged to increase standardization and interoperability by using the following strategies:
- Using standard healthcare vocabulary 
- Using standard and secure protocols during data transfer 
- Using the National Institute of Standards and Technology’s (NIST) encryption criteria to ensure security standards 
- Offering standard services by having accessible application programming interfaces (APIs) 
If health care organizations collectively work towards using and perfecting these solutions, it will help solve many of the challenges that HIEs face. Undoubtedly, HIE technology greatly improves patient care and is an indispensable tool for the overall success of present-day health care organizations.
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About Nicole Preston:
*: Nicole Preston is EnduraData’s mass communications specialist. She holds a BA in Journalism and Mass communications from the University of Minnesota.