EMR Benefits: HIE

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Health Information Exchange (HIE)

With better information integration capability, it allows for healthcare institutions to facilitate better quality care, contain costs, and better manage risks. Thus, by having healthcare organizations that incorporate an EMR, it enables for both clinical and business advantages by in turn creating a clinical healthcare system that helps to unite crucial patient information with various departments. As a result, this helps to create a central clinical information repository and resource used throughout the integrated delivery network of the institution. This in the long run allows for the different information of patients to be coalesced together in a timelier manner, which can reduce errors in diagnosis. EMRs allow for interoperability such that multiple clinicians and facilities may use or add to a patient’s record, even at the same time.

HIEs help reduce costs by facilitating better coordinated care and reduce redundant and unnecessary testing. Other benefits of HIE include improving public health reporting and monitoring. Most importantly, it can serve as a method for interoperability between EHRs that would have difficulty communicating otherwise. [1]

The advent of the Health Information Exchange (HIE) allows for sharing of patient information electronically within an organization, system, community, region or state. This helps in monitoring not just a patient's health but health in certain subsets of populations, whether for a certain diagnosis group or within a social demographic or a geographic region. Stratifying the data to look for trends over areas, ethnicities or over time has helped in development of software models which help in predicting the health of not only a patient but also patient populations over time. Metrics such as 30 day readmission are used commonly in healthcare to gauge the quality of care of a patient and is an example of where predictive modeling is being used. EMR has allowed for transparency, and the analysis of data has helped to establish trends and patterns. Big Data is another commonly used term in healthcare and refers to the availability of large amounts of data available from the collection of patient EMR records.

Health information exchange (HIE) is the electronic transfer of healthcare information between various organizations. This has become an important topic because it improves the quality, safety and efficiency of healthcare. Electronic health records (EHR) helps to facilitate the electronic exchange between hospitals, clinics, and patients much more possible. According to the Department of Health and Human Services, 84% of hospitals that adopted EHR and participated in regional HIO exchanged information w/ providers outside organization. HIEs also assist with provider/patient interactions regarding chronic disease management. One example of this looks at Western New York (WNY) Beacon Community and the regional health information exchange (HIE) HealtheLink. The two organizations teamed up to help diabetic patients in upstate New York with disease management. The cost of diabetes management has risen from $174 billion in 2007 to $245 billion in 2012; that is a 41% increase over five years (American Diabetes Association, 2014). These figures address an increased in financial burden, use of health resources and lost productivity associated with diabetes (American Diabetes Association, 2014). In response to this rise in cost, WNY Beacon has shared strategies not only improving the health of diabetic patients, but cutting costs for such management as well. Their strategies cover three primary topics: 1) expanding research for better analytics, 2) improving real-time care coordination and communication and 3) patient education, telehealth and population management.

Aside from the Kaiser HMO and the VA system, considered the nation's best examples of Health Information Exchange (HIE), there are two other such HIEs, Indiana Health Information Exchange (IHIE) and Rhode Island Quality Institute (riqi.orrg) worth mentioning. They're mentioned here to introduce the idea of federated data management (as against the traditional centralized data management approach) by keeping ownership of data at source (Physician Practices) and introducing data lockers to get access to data for Analytics & Reporting purposes, thus minimizing data aggregation, normalization and security expenses. [2]

Virtual Lifetime Electronic Record (VLER), a program initiated in April 2009 by President Obama designed for the VA and DoD to lead the efforts in creating VLER (Virtual Lifetime Electronic Record), which would “ultimately contain administrative and medical information from the day an individual enters military service throughout their military career and after they leave the military.” VLER avails the eHealth Exchange to share prescribed patient information via this protected network environment with participating private health care providers, with exception of ‘scanned’ patient information. [3]

The Direct Project

Standards of information exchange are beginning to take hold for purposes of summarizing a patient record or event or allowing a provider to query for records across a community. The Direct Project aims to utilize these standards as well to replace methods of information exchange such as fax, courier, postal mail, and patients themselves that continue to slow down and predominate the health care field for transferring lab results, x-ray results, reminders for Dr. visits, etc. [61]

The project is sponsored by the Office of the National Coordinator for Health IT (ONC) but led by volunteers in the industry. The Direct Project offers a simple, non-proprietary solution for direct information exchange between two healthcare entities. [51]

It is important to note here another emerging standard called Fast Healthcare Interoperability Resource (FHIR), pronounced "fire", is expected to meet the standards of the market needs in the areas of Mobile HC apps, Medical devices and Custom workflows and also drive new efficiency in terms of care coordination, cost of care optimization, patient engagement and behavior influence of both care delivery folks as well as patients. [4]

Improving care with HIE

The role of Clinical Event Notifications through HIE in geriatric emergency department

Having Clinical event notification systems on a patient and sharing the information with all the health care providers through Health information exchange tools like EHR logs, email, clinician text improves patient care, unnecessary ED admits, duplicate testing and cost. [5]

The first study done to show evidence of the benefits of HIE was an association between HIE use in emergency departments and decrease in redundant imaging orders.


  1. HIE Benefits. http://www.healthit.gov/providers-professionals/health-information-exchange/hie-benefits
  2. Braunstein, Mark (08/2014) Excerpts from Interviews with John Kansky Interim President, CEO, IHIE, Laura Adams, CEO Rhode Island Quality Institute
  3. Health benefits. http://www.va.gov/healthbenefits/resources/publications/IB10185_Health_Care_Overview_2014_Eng_V6_web.pdf
  4. Muir, E. (2013, March 3). What is 'FHIR' and why should you care? Retrieved January 26, 2015, from http://www.interfaceware.com/blog/what-is-fhir-and-why-should-you-care/
  5. Gutteride et al, (2014). Enhancing a Geriatric Emergency Department Care Coordination Intervention Using Automated Health Information Exchange-Based Clinical Event Notifications. http://repository.academyhealth.org/egems/vol2/iss3/6