Whether you take “Health Information Exchange” (HIE) to be a noun, a verb, or both, depends on your point of view about mobilizing healthcare information electronically across systems within establishments, serving communities, or between regions. In each case, the end-goal is the same: to make access and retrieval of clinical data easier for patient-centric care that is timely, efficient, effective, and safe, whether to individual patients, groups, or communities.
The shift from paper-based to electronic systems is crucial for properly managing changes in the location of treatment for patients. Examples include retirees moving around seasonally and patients displaced by natural disasters. It is also essential for changing the focus to patient-centered care for chronic ailments like diabetes, whose treatment requires the intervention of several medical specialists. Community-wide, regional and national use cases include recalls of pharmaceuticals from the market and analysis and containment of pandemics such as major flu outbreaks.
Learning from the Short Lives of the CHMIS and the CHIN
A number of the early HIE implementations followed one of two models:
- Community health management information system (CHMIS). A centralized data storage facility held demographic, medical and healthcare eligibility information on individuals in a geographical community. The information was available to local health agencies, insurers and researchers, among others. The CHMIS also contained a transaction system for ease of billing and eligibility information retrieval, to reduce costs.
- Community health information network (CHIN). These networks were primarily commercial enterprises, differing from the CHMIS model that was sponsored by community and health assurance stakeholders. Cost savings in moving data between providers were a key objective. There was no centralized data storage facility; providers kept their databases separate and relied on transactions between databases to exchange data.
In the 1990s when these HIE prototypes started, hardware, software, and networking were expensive, and the integration of different data sources was a challenge. With the additional challenge of less than optimal usability, neither the CHMIS or the CHIN implementations survived into the current century in any great numbers. The situation was also complicated further by operational decisions to implement electronic health record (EHR) management systems as a priority over interoperability. This preference was also encouraged by a lack of agreement between healthcare organizations on which information exchange standards to adopt and which rules and business practices to use.
Objectives and Incentives for the HIE Today
The current situation is that health IT interoperability is a reality in some areas, but more of a pious wish in others. The requirement for workable, economically viable health information exchanges remains. The 2015 report, “Connecting Health and Care for the Nation, A Shared Nationwide Interoperability Roadmap” from the Office of the National Coordinator for Health Information Technology (ONC), calls for healthcare entities to enable their systems to communicate and use “a common set of electronic clinical information … at the nationwide level by the end of 2017.”
The State Health Information Exchange Cooperative Agreement Program offers funds to states that undertake to rapidly build HIE capacity across healthcare systems intra and interstate, “increasing connectivity and enabling patient-centric information flow to improve the quality and efficiency of care.” The challenge for states lagging in their HIE has been to understand, decide, plan and implement HIE in a condensed timeframe. Short-term IT interoperability goals may swamp out more strategic considerations, such as the stakeholders that should be involved and the IT governance model that is most appropriate.
Short Term and Long Term ROI on an HIE
Showing value is a problem for many health information exchanges. Those that show or tend towards positive returns on investment (ROI) often rely on the basic cost savings (compared to traditional paper/phone-based systems) from using electronic transmission and delivery confirmation of test result reports and patient charts and records. Time and effort saved in recovering missing patient information is also a factor.
Aside from looking after more technical aspects, IT teams will have an important role to play in helping their organizations keep both long and short term goals in mind. On one hand, use cases such as the electronic transmission of test result reports will be important to justify State HIE Cooperative Agreement Program aid. On the other hand, they must not divert attention from longer-term goals of interoperability based on compatible IT architectures and accepted industry or international standards.