This is the second part of a two part blog on Health Information Exchanges (HIE) – if you have not done so already, check out Health Information Exchanges: What are They…And Why Should You Care? (Part 1) to learn what HIEs are and their enormous potential benefits to clients, clinicians, administrators, educators, and researchers across all health care settings.

What are the challenges of HIEs and how will exchange of data actually occur?

Obviously, a variety of different EHRs will be used by the various entities involved in a single HIE, regardless of size.

There is no “one size fits all” EHR that can be used by every provider, program, or agency to document their work with an individual client or patient.

So, the adoption of common interoperable standards is a required and necessary component for documents such as summaries of care to be transmitted from one agency to another.

(Tip:  If you are looking for an EHR software system at this time for your program, be sure to talk to your vendor about what standards are included in its software, including clinical language terminologies (such as the Omaha System) that are mapped to accepted standards such as LOINC and SNOMED-CT.)

9470017_l-resized-600According to, shared standards are particularly critical in the following four areas:

  • How applications (software) interact with each other (such as in prescribing medicines)
  • How systems communicate with each other (messaging standards)
  • How information is processed and managed (in a health information exchange)
  • How consumer devices integrate with the systems and applications

Challenges that need to be resolved within and among health information exchanges include:

  • Poor quality data shared by a provider or program and/or error follow-up (need to establish who has the authority to define what is poor versus good quality data and how to enforce data quality rules across all exchange members)
  • Inadequate or untimely responses or feedback to other providers/exchange members
  • Cost – who will pay for the costs of maintaining the exchange?
  • Lack of a single standardized format in messaging protocols (how a data message, such as a patient summary or a continuity of care request, can be “published” – created and sent — so that all the involved EHRs can understand and “consume” – receive and incorporate — it into their own applications)

Like most other things in life, the devil is in the details.

The Consolidated CDA (Clinical Document Architecture) is emerging as a single standard for continuity of care/patient summary records and is based on the Health Level Seven International (HL7) interoperability standards.

In contrast, “transport” exchange protocols to move the C-CDA to and from the EHRs are still developing. These protocols govern issues such as patient identity and consent, recording when and where the document was created, etc.

14598608_l-resized-600What YOU can and should do regarding HIEs

Whoa, you may be saying.  I am not an IT expert, nor do I want to be – what can I do about exchange of health information in my program or agency or in a larger HIE to which we belong or may belong in the future?

Well, simply put, if you are not at the table when these issues are being discussed, you run the very real risk of your program’s contributions to your community members being left out of the types of information that will be exchanged.

Do you rely on referrals and respond to referral sources?

If so, then you need to be at the table.

Do you provide mandated services in response to communicable disease investigations or mass casualty events?

If so, then you need to be at the table.

Come to the table informed – if your program or agency is not using an EHR, work with others to research and ask questions of software vendors.

Educate yourself further by going to the websites below and attending meetings and conferences where these issues are being discussed.

You will benefit, your program will benefit, and most importantly, your clients will benefit as well.

HIE references and resources you should be aware of:

Healthcare Information and Management Systems Society