What is HIE
There are many definitions of HIE – Health Information Exchange. Health information exchange (HIE) may be defined as the mobilization of healthcare information electronically across organizations within a region, community or hospital system. Or, it can be described as infrastructure that enables the exchange of health information. Simply put, HIE is the secure, electronic exchange of health information among authorized stakeholders in the healthcare community – that include care providers, patients and public health agencies to provide more timely, efficient, effective, equitable, patient-centered care. The final goal of course is to have EHR for every American by 2014 along with better health care at lower costs.
Why Is It Important and Why Now?
Of course, the easy answer is there is never been a perfect time to reform or improve healthcare in America! There is enough data out there that shows healthcare can be delivered much more efficiently in the United States. The debate has always been on how to do it. And, everyone(physicians, patients and the government) is convinced about the benefits modern IT technologies can bring to healthcare system. Therefore all this talk about stimulus and EH R adoption and so on. The HIE program (with E HR adoption) will ensure:
- Significant reduction in duplicate testing. Studies indicate the same drug or a radiology exam is ordered 11% of the time and patients comply with the duplicate 50% of the time.
- Less Uncertainty: One in seven admissions and one in five lab tests and radiology exams gets ordered due to retrieval barriers. Also, a typical physician receives test results from five or more locations
HIE will change all that. It will break down barriers and will make information available to all authorized providers (users) in a secure manner. The result is better care and lower costs. HIE will transform the country’s healthcare system with new delivery models, reimbursement regulations and holds a myriad of benefits for Physicians, Hospitals and patients.
Our government has committed over $500 million to various States to create regional HIEs or organizations. There are several HIE (platform) vendors, notably Medicity and Axolotl (recently acquired by Ingenix) and technology behemoths like Microsoft, Google and IBM who are trying to make inroads into this fairly new market. Simplistically speaking, there are essentially two models for any information exchange, and, HIE is no different.
Centralized Model: This approach involves all information creators (or content producers) pushing their content to a centralized repository – in real time. Users can pull the information from this repository on demand in real time. (think Cloud computing). The key feature of this approach is big government involvement. Government investing monies in hardware and software, building clusters of databases, assigning national identifiers for Physicians, publish specifications for data that can be sent or pulled, etc. EH R vendors will build web services and will integrate them in their technology and processes.
Federated Model (or Call it the Distributed Model): Health information is maintained where it is created. It may be a clinic or physician office, hospital, therapy center or any other patient care facility. In this approach, contributors will push content to users if they want to and users will pull content from contributors when they need to. This is somewhat of a traditional telephony model. You make a contact or send or receive any information – i.e. when you want to. In this kind of communication between so many disparate entities, knowing the same language and know each other’s phone number is important- euphemistically speaking! The biggest barrier to success of this model is lack of open standards. As we are all aware, healthcare systems across the country use proprietary system and it is fairly common to find E HRs not talking or communicating with each other using open transmission protocols. No one knows for sure how the final HIE will look like. Initial deployments and trends indicate that it will be somewhat of a hybrid of the two models though.
Few Implementations
1. HealtheLink, the eight-county western New York State HIE whose service area includes Buffalo and Niagara Falls, got its start in 2004. Several state and federal grants helped pave the way over last six years and now HealtheLink has more than 700 providers and 3,000 users (including physician staff) sharing health information.
2. The Utah Health Information Network (UHIN) had a different start from most HIEs. It began in 1993 as an electronic administrative exchange, sharing claims, remittances, eligibility orders and other HIPAA-compliant data exchanges, and now covers 90 percent of the medical providers in Utah.
3. The Michiana Health Information Network (MHIN) serves more than 3,200 community healthcare professionals in northern Indiana and southwest Michigan. From 1999 to 2005, the basis of the exchange was jumpstarted with the participation of the South Bend Medical Foundation, an organization that provides cost-effective laboratory and blood banking services to communities in Indiana, Michigan, Kentucky, Ohio, and Illinois, and the six-facility Saint Joseph Regional Medical Centre in north central Indiana. Now the exchange includes more than 1,000 physicians, seven hospitals, more than 15 extended care facilities, radiology practices and more.
As we write, State HIEs are busy selecting and deploying various HIE platforms, using a wide range of privacy and security policies and standards for communication technologies. There will definitely be a lot of distributed or federated structure in the overreaching NHIN – Nationwide Health Information Network – which is under construction. To be sure, specification work on NHIN is far from complete. There are other private smaller, HIE networks being built. Large EHR vendors are building to run their own proprietary peer-to-peer networks across organizations, and, everyone (platform & organization) promises “seamless” integration of all these conflicting initiatives.
Where do we go from here? No one knows for sure. What we know for sure is exchange and sharing of healthcare information among stakeholders will look vastly different in 2014!
