Electronic health information exchange
Electronic health information exchange
Overview
The efficient, effective and equitable delivery of care is vital to the well-being of patients, their families, and the community as a whole. In order to meet this need and improve the care it requires information to be exchanged among various groups so that health professional have the information they need to make informed decision that impact lives. Electronic health information exchange (HIE) offers a way for clinicians and organizations to electronically send and receive complete patient information between different facilities and systems that would normally not be able to communicate. HIE began at a time where technology, system standards, and health IT vendors used diverse and disconnected programs; creating a barrier to access patient records, health histories, and pertinent laboratory, radiology, and pathology results or orders. This was a significant deficit in quality of care, as it limited clinicians' ability to see the full picture and properly evaluate, assess, diagnose, and treat their patients. About 15 years ago, HIE began to transform into a more mature tool for care coordination, leading to the emergence of four primary roles of HIE(1):
1. Interconnectivity -- HIE tools help organizations avoid custom, point-to-point connections, where each provider must create a separate connection to every other system, service, and provider they want to communicate with
2. Clinical document exchange -- Efforts taken to ensure providers follow regulations that have established a minimum set of elements that providers should exchange to coordinate care; currently the "Continuity of Care Document (CCD)"
3. Creating a community health record -- Regional HIEs can consolidate a patient’s health information into a community health record, which is a more complete picture of the care a patient is receiving
4. Encounter notifications -- HIE can be used to alert clinicians and other members of a patient's care team to make providers aware of recent encounters, health problems, emergency needs, etc. to ensure proper follow up and intervention is taken
Advantages
Disadvantages & Strategies
Issues can be categorized into three groups: technological, fiscal, and organizational --
1. Fiscal
The primary fiscal issue is the lack of a viable business model for information exchange. A recent study of RHIOS by Julia Adler-Millstein, David W. Bates and Ashish K. Jha found that 41 percent of operational RHIOs reported that revenue from participating entities was sufficient to cover costs, and of the remainder, only 28 percent expected that revenue over time would adequately cover costs. Initial funding has been helpful in facilitating the participation of health centers in exchanges, but it does not address the issues of staying in an exchange longer term. Thus, support for ongoing operating costs and financial sustainability over time are important considerations(2).
2. Access & user friendliness
Patient health information is growing and becoming increasingly available electronically — but patients and caregivers still face challenges in accessing their data. Patient portals may not include all the information patients need, what’s there may be inaccurate or incomplete, and often, users cannot initiate electronic transfer of their health data to other health care providers.
Protocols & standards
The purpose of HIPAA is to improve the efficiency, effectiveness, and security of the national health system.
Increase efficiency: paper work is reduced for healthcare providers due to an electronic system.
Reduce fraud and abuse: digital paper trail makes fraud prosecution easier.
Portability: an employee is guaranteed health insurance coverage, even when he changes jobs.
Security: increased security for patient health information and protect patient rights.
Accountability: protecting health data integrity, confidentiality and availability.
To comply with the security standards, an electronic medical record (EMR) must have written, comprehensive security policies, access controls, control over the physical environment, clearance procedures, and a record of all access authorizations.
Sources
Submitted by (LeeAnn Farestrand)
