This article is designed to give a basic overview of HIE (health information exchange), and explain what an HIE is and what it can mean to public health personnel.

Health Information Exchanges are a crucial piece of the data exchange puzzle.

While HIE is a somewhat common term among public health personnel and many health workers are well-informed, others may be stepping into the world of HIE for the first time or may wish for a better understanding of the subject.

A Basic Overview of HIE:

HIE stands for Health Information Exchange.

An HIE is the software (and company that builds and maintains the software) that enables the exchange of health information using industry accepted standards.

  • Some HIEs are run by private companies and some are run by state government
  • Some HIEs are set up to exchange health information to participants across the state and others can exchange data across several states
  • Some states even have multiple HIEs within the state

An HIE is a way for different care givers to share clinical information electronically while maintaining HIPAA compliance.

In very simple terms, it’s how County A could electronically request a client’s health information and securely receive it from County B, when they need it.

An HIE allows providers to exchange this data in a way that both parties will understand, so that the data is meaningful to both the sender and the receiver.

The entities who use and submit data to an HIE represent many different types of providers, including:

  • Hospitals
  • Clinics
  • Public health agencies
  • Laboratories
  • Long-term care facilities

An HIE can exchange health information a few different ways, depending on their capabilities and the ability of the providers participating in the exchange to send and receive information.

Two basic methods HIEs can use to exchange data are:

  • Query-based (also known as a “pull”)
  • Directed (also known as a “push”)

Pull

A query-based exchange occurs when a provider logs into the HIE and queries the exchange, looking for a patient’s information.

For example, if a patient is taken to an emergency room, the physician can use the HIE to look up any health issues or current medications the patient may be taking.

This is referred to as a data “pull.”

Push

A directed exchange occurs when a provider sends health information about the patient to the HIE.

For example, if one provider is referring the patient to another provider, the patient’s health information could be sent to the referred provider securely via the HIE.

Another example of this is when a health department administers an immunization to a patient.

That data can then be updated in the patient record and accessed by other providers via the HIE.

This is referred to as a data “push.”

But what do HIEs mean for public health?

For years patient medical records were transferred either by the patient themselves, as they carried their medical history from provider to provider, or by fax machine.

An HIE offers many advantages over historical methods of exchanging patient data.

Here’s how and why:

Automatically connect

Firstly, it offers public health professionals the ability to automatically connect to the HIE to obtain patient medical data, versus the historical need to manually transfer patient information.

Standardization of information in the patient record

Another key benefit of health information exchange is the standardization of the information in the patient record.

In order to be able to send data to the HIE, an electronic health record (EHR) has to have the ability to put that data into a commonly understood language, with standard fields, so that it can be understood by a receiving provider (see more information under “CCD” below).

Most up to date information

An HIE also gives public health professionals access to the most up to date patient information in the medical record.

This helps reduce the chance of medication errors or misdiagnosis, along with eliminating duplicate testing.

It also helps improve accuracy in diagnosis, improves public health reporting, protects patient safety by providing the full medical picture, and helps reduce costs.

Patient information is held in one place

In addition, the the public health professional knows exactly where to obtain patient information, because it is all held in one place, the HIE.

This is especially helpful in cases where a patient:

  • Might not remember where they were seen last
  • Might be unable to communicate that information to the provider

Level playing field

What might arguably be the best benefit an HIE can offer public health is a level playing field.

An HIE gives public health as much priority as a hospital.

While a public health agency might be providing a different type of care, it is no less important

Transient population

Lastly, the population treated by public health personnel are much more likely to be transient, moving between cities or states.

As with hospitals and clinics, the ability to pull or send a client’s health record helps ensure those clients are receiving continuity of care and getting the best treatment possible even if they move.

The best way to ensure you can exchange meaningful data is to employ an electronic health record (EHR) that can create and send CCDs  and that can also allow you to chart data in a consistent, meaningful way through the use of a standardized terminology such as the Omaha System.

Terminology

If you’ve ventured very far into examining HIEs or reading up on them, you’ll notice there are a lot of acronyms that get thrown around.

The discussion surrounding HIEs sometimes takes on a language of its own.

Here are some common terms and acronyms you may encounter and what they mean:

There are two types of HIE entities:

  • HDI – Health Data Intermediary
  • HIO – Health Data Organization

One focuses on the technology (backend) and the other focuses on the people, business, management of the data.

HDI

A Health Data Intermediary (HDI) provides the technical software, hardware and products or services to enable exchange of healthcare data with an HIE.

Some examples of the software, hardware, products or services the HDI provides include EHRs and Health Information Service Providers (HISPs).

HIO

HIMSS uses this definition, “A Health Information Exchange Organization (HIO) is an organization that oversees and governs the exchange of health-related information among organizations according to nationally recognized standards.

The purpose of an HIO is to perform oversight and governance functions for HIEs.”

Not everybody wants to build the software to handle data exchange but some organizations may want to manage a group of entities that use data exchange software.

The HIO manages the HIE from a business and rules perspective but does not own, operate or maintain the software.

CCD

A CCD is a Continuity of Care Document; it’s an electronic document that incorporates a patient’s healthcare data and is able to be exchanged with other health providers.

It is how the patient’s information is packaged in order to be sent to the HIE.

Data for the CCD has to be compiled using a document standard so that the data can easily be accepted and understood by another provider’s system.

The document standard also ensures the data is documented and measured in the same way so that it means the same thing no matter what provider is reading or recording the data.

HL7 is the organization that sets that standard.

HL7

HL7, as stated above, is the organization the sets the document standard for how information is recorded and packaged before being sent to the HIE.

Health Level 7 (HL7) international describes itself as follows, “HL7 and its members provide a framework (and related standards) for the exchange, integration, sharing, and retrieval of electronic health information.

These standards define how information is packaged and communicated from one party to another, setting the language, structure and data types required for seamless integration between systems.

HL7 standards support clinical practice and the management, delivery, and evaluation of health services, and are recognized as the most commonly used in the world.”

ONC

The Office of the National Coordinator for Health Information Technology (ONC) is a government entity under the US Department of Health and Human Services.

Its purpose is the, “…coordination of nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information.”

The ONC was established to, “support the adoption of health information technology and the promotion of nationwide health information exchange to improve health care.”

ARRA

The American Recovery and Reinvestment Act (ARRA) was a very large stimulus package created by the federal government in 2009 in response to the recession.

It’s purpose was to preserve and promote jobs and to help promote economic recovery.

There were many programs created under ARRA, but the piece pertinent to this discussion is ARRA’s authorization of, “the Centers for Medicare & Medicaid Services (CMS) to provide incentive payments to eligible professionals (EPs) and hospitals who adopt, implement, upgrade, or demonstrate meaningful use of certified electronic health record (EHR) technology.”

Meaningful Use

Meaningful Use, sometimes abbreviated “MU,” encompasses the specific objectives that providers have to meet in order to qualify for ARRA incentive payments.

To be Meaningful Use certified means that an entity (whether a provider, EHR vendor, etc.) has met the qualifications and standards for that particular Meaningful Use certification.

While not all providers will qualify for ARRA incentive payments- whether or not they are Meaningful Use certified, Meaningful Use has become synonymous with a standard for the “meaningful use” of health information technology, including EHRs.

Part of Meaningful Use standards is the qualifications set out for the electronic exchange of health information, including through HIEs.

EHR vendors, in order to be Meaningful Use certified, must prove that they meet certain standards.

A Brief History: An HIE Timeline

To provide some context for understanding HIEs and what they mean to public health, here is a brief history of the United States efforts around health information exchange:

1929

  • John and George Hartford, very wealthy owners of the A&P grocery chain create  The Hartford Foundation
  • They distribute some of their wealth toward projects that align with their mission “to do the greatest good for the greatest number”

Fast forward to…

1990

  • A program, Community Health Information Management System (CHMIS) was formed by the Hartford Foundation to build a centralized data repository in seven communities
  • They were ahead of their time and unfortunately the communities didn’t have the technology, laws around privacy and security, connections to the providers, or local support to make it work
  • This was probably the first organized attempt though at sharing health data for the purpose of the greater good and of the individual.

1990 – 2004

2004 – Present

  • Standards for data exchange are developed and evolve
  • State and national efforts to find centralized ways to coordinate sharing of data result in both private and state-run health information exchanges
  • Changes in policy around health records also come into play during this time with the 2009 American Recovery & Reinvestment Act (ARRA) which included incentive funding of $36 billion to move to electronic health records through Meaningful Use of health information.

Additional Resources:

“Understanding HIE, Assessing Your Readiness and Selecting HIE Options.” Minnesota Department of Health. Office of Health Information Technology. Jul. 2013. PDF. http://www.health.state.mn.us/divs/hpsc/ohit/hieguidance/hieguide.pdf. 30 Apr. 2014.

“What is HIE?” HealthIT.gov. Office of the National Coordinator. n.d. Web. http://healthit.gov/providers-professionals/health-information-exchange/what-hie. 30 Apr. 2014.

“What are the benefits of health information exchange?” HealthIT.gov. Office of the National Coordinator. n.d. Web. http://www.healthit.gov/providers-professionals/faqs/what-are-benefits-health-information-exchange. 7 May. 2014.