Indiana Health Information Exchange
The Indiana Health Information Exchange (IHIE) is a non-profit health information exchange (HIE) located in Indianapolis, Indiana. It serves a large percentage of hospitals across the state of Indiana and was one of the first HIEs introduced.
- 1 History
- 2 Core Features
- 3 Data Repositories
- 4 Clinical Platforms
- 5 References
IHIE was formed in 1996 with the alliance of the five largest hospital groups in Indianapolis and initially created as the Indiana Network for Patient Care (INPC), a data sharing collaborative that at its formation primarily focused on patient seen in the emergency departments (EDs) of the hospitals in each of the hospital groups. The INPC was originally created and supported by the Regenstrief Institute.
Departure from Regenstrief
In 2004, IHIE was officially incorporated as a non-profit organization separate from Regenstrief. While the two organizations freely share data and software fixes and enhancements, the ongoing maintenance of the INPC and its associated services falls to IHIE.
IHIE has a number of core features that enable its services. As a requirement of participation, all institutions must agree to freely sharing their data among other participating parties, maximizing the data access for all involved.
Data Sources and Mapping
IHIE receives HL7 data feeds from each of its participating institutions and stored in the INPC (see below). As data flows, it is normalized and mapped to allow the data to be compared and trended with data from other participating members. This is accomplished by assigning a standardized Regenstrief term (each term associated with a corresponding LOINC code) to each result. A lab mapping team monitors codes that fail to be assigned and works to create new Regenstrief terms as needed for unmapped terms. 
As data is collected, a key feature enabling interoperability is patient name matching. This involves the use of patient matching algorithms, many of which were developed initially at Regenstrief.
Data Security and Privacy
A key security and privacy feature of the exchange is the all-or-nothing access of data. Access to patient data is only available when triggered by events such as user registration in an ED or inpatient environment, scheduling of outpatient appointments, and other triggers of clinical care that would necessitate access to the requisite data. Once access is enabled, the entirety of a patient's medical record is viewable. Outside of these windows, access is completely disabled.
The Indiana Network for Patient Care (INPC)
The INPC was the initial data repository at the founding of IHIE, and it remains the primary source of clinical data in the system. As of 2011, the repository had "over 3 billion discrete results, including 840 million encounters, 1.7 billion clinical observations, and 580 million claims observations (procedures, prescriptions, etc)."
Despite IHIE and Regenstrief being separate entities, the two enjoy a rich research and data sharing relationship. The INPC-R was created to provide Regenstrief with its own repository of clinical data for the purposes of research.
DOCS4DOCS was the first product introduced by IHIE upon its incorporation in 2004 to fulfill the need of physicians to monitor their patients across facilities. The platform has grown tremendously and now covers physicians in over 100 hospitals and clinics throughout the state of Indiana. Supported documents include admission/discharge summaries, lab and radiology results, cardiology studies, and continuity of care documents (CCDs). Modalities of transmission include fax, e-mail, web access, and HL7. Support for FHIR is in process, eventually enabling the push of results to the electronic health record of the patient's primary hospital system.
As the popularity of DOCS4DOCS increased and with it the awareness that patient data from outside sources could be accessed, demand grew for a similar application that could be used by providers other than a patient's primary physician. Emergency departments in particular were interested in accessing this data as patients often present to EDs outside their usual hospital network. This interest led to the creation of CareWeb, a resource available to any facility that is part of the IHIE network. Data including lab and ancillary testing results can be trended across institutions.
Population Health Services
IHIE's most recent efforts have focused on using the data in the INPC to enhance population health. One such application is the application of network data to provide reports to providers who are part of an Accountable Care Organization. As an example, the recent Comprehensive Care for Joint Replacement (CJR) model put forth by the Centers for Medicare/Medicaid requires many orthopedic surgeons to be held accountable for the care of their postoperative patients for the 90-day period follow the procedure, no matter where the patient chooses to follow up. If a patient presents to an ED outside of the initial hospital network where the procedure was performed, the cost of that visit falls on the original surgeon. In this case, the key benefit of IHIE is that it could trigger a notification to an orthopedic surgeon that her patient is potentially having a complication of surgery in a situation where that information might otherwise be unavailable. Another example is the automated reporting of notifiable diseases to the Indiana State Department of Health, a process which previously required filling out an extensive, time-consuming paper form.
Submitted by Dan Seitz