Health information exchange

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Health information exchange (HIE) is defined as the mobilization of healthcare information electronically across organizations within a region, community or hospital system.

HIE provides the capability to electronically move clinical information among disparate health care information systems while maintaining the meaning of the information being exchanged. The goal of HIE is to facilitate access to and retrieval of clinical data to provide safer, more timely, efficient, effective, equitable, patient-centered care. HIE is also useful to Public Health authorities to assist in analyses of the health of the population.

Formal organizations are now emerging to provide both form and function for health information exchange efforts. These organizations (often called Regional Health Information Organizations, or RHIOs) are ordinarily geographically-defined entities which develop and manage a set of contractual conventions and terms, arrange for the means of electronic exchange of information, and develop and maintain HIE standards.^[1]

Contents 1 History 2 Additional Communities 3 See also 4 References 5 External links

[edit] History

Some of the oldest RHIO's actually date back to the 1990s. The eHealth Initiative ranks the Indiana HIE as the most advanced and successful.

In 1994, with funding from the National Institutes of Health and the National Library of Medicine, the Regenstrief Institute Medical Informatics division extended the RMRS to the Indiana Network for Patient Care (INPC), a city-wide clinical informatics network.^[2]

All INPC participants now deliver registration records, all laboratory tests, and all UB92 records (diagnosis, length of stay, and procedure codes) for hospital admissions and emergency room visits to separate electronic medical record vaults in a central INPC server located at Wishard Hospital. The message exchange standard that is used is HL7. The computer system standardizes all clinical data as it arrives at the INPC vault, laboratory test results are mapped to a set of common test codes LOINC with standard units of measure, and patients with multiple medical record numbers are linked. Each institution has the same file structure and shares the same term dictionary which contain the codes, names (and other attributes) for tests, drugs, coded answers, etc. When a patient is seen in any of the 11 emergency rooms operated by the consortium hospitals, and the patient consents, the information from all of these institutions about one patient can be presented as one electronic medical record.^[3]

One of the largest, actively functioning, and few self-sustaining Health Information Exchanges involves the same group of medical informaticists from the Regenstrief Institute in collaboration with the major hospital systems in the region. It is called the Indiana Health Information Exchange. The first services delivered by IHIE include electronic delivery of test reports to physician offices using faxes, printers, or an electronic/ web based mail box (DOCS4DOCS Clinical Messaging System). According to their own website, their aim is to:

• Improve the quality, safety, and efficiency of health care in the state of Indiana ,
• Create unparalleled research capabilities for health researchers,
• Exhibit a successful model of health information exchange for the rest of the country.

The Michiana Health Information Network located in northern Indiana was established in 1999. Since its inception the exchange has been able to successfully operate without grant funding as is self sustaining today. The network provides electronic result delivery with push technology, interface services for physician practices EHRs and institutional software, its own electronic health record and a series of products supporting clinical registries and health quality improvement. MHIN is dedicated to the improvement of care and the reduction of medical cost in the Michiana community.

To get a customer's perspective on the use of a HIE see the Medical Economics article: "Why these doctors love their RHIO"

Peer reviewed commentary on the value of a HIE^[4] and how HIE are intimately related to quality health care.^[5]

[edit] Additional Communities

See the eHealth Initiative Directory for profiles of all major regional HIE efforts.

OpenHRE Community The OpenHRE™ Community is a consortium of communities and organizations throughout America that are working together to achieve secure and sustainable health information exchange. Established in 2004, the OpenHRE™ Community shares important findings and deliverables with each other, and collectively contributes to the continuing design, development, and distribution of the OpenHRE™ Toolkit, developed by Browsersoft, Inc. The OpenHRE Toolkit was used to deploy the Nation's first Multiple Health Market Health Information Exchange between Indianapolis, Boston and Mendocino CA, a demonstrated Nationwide Health Information Network (NHIN) Prototype via. DHHS contract, and working Health Information Exchanges representing Statewide, Metropolitan and Rural initiatives throughout America.

LIPIX - Long Island Patient Information Exchange is an independent, not-for-profit corporation established to develop a Regional Health Information Organization (RHIO) for Long Island, NY. Headquartered in Manhasset, NY, LIPIX’s primary mission is to fundamentally improve the quality and efficiency of healthcare for the betterment of patients, providers and LIPIX with the ultimate goal being to organize the world’s health information so that it is globally accessible and useful while maintaining the highest standards of patient privacy.

Healthcare Access San Antonio (HASA) a health care consortium and OpenHRE Community Contributor serving the medically uninsured in Bexar County, TX. HASA participants include the seven major safety net hospitals, City of San Antonio Metropolitan Health District (Immunization Data) and a network of community FQHCs serving the uninsured of San Antonio. The SecureShare centralized community repository contains demographic and clinical records for over 500,000 uninsured patients. Achieving "Meaningful Use" and expanding scope of functioning HIE by producing analytics and reports for key business metrics (i.e. Frequent Flyers in ERs) and clinical conditions (Diabetes, Hypertension, Asthma).

CareSpark CareSpark is an innovative effort underway in the central Appalachian region that is working to improve health through the collaborative use of health information. CareSpark's mission is to improve the health of people in their region through the collaborative use of health information, enabling patients and health professionals to be better-informed and more engaged in decisions affecting personal health and wellness. CareSpark region includes 17 counties in the Tri-Cities Tennessee and Virginia area with approximately 750,000 residents, 21 hospitals, and 1,200 physicians.

Eastern Kern County Information Technology Association (EKCITA) a rural community association and OpenHRE Contributor in California achieving the first functioning community Health Information Exchange West of the Mississippi. EKCITA has deployed secure and appropriate sharing of electronic health files and clinical data for public health, patient care, and research. The EKCITA deployment provides community caregivers access to over 32,000 local patient health profiles.

Bayou Teche Community Health Network (ByNet, Franklin LA.) a non-profit, rural health network and OpenHRE Contributor comprised of community health centers, local and regional hospitals and FQHCs, a social service agency, a tribal health clinic, a regional State of Louisiana Office of Public Health, and a coalition of over seventy St. Mary Parish organizations. The ByNet centralized repository contains demographic and clinical records that will exceed 100,000 patients.

Kansas Health and Environment (KDHE) Diabetes Quality of Care Project The Kansas Diabetes Quality of Care Project involves over 68 funded organizations at 90 provider sites across the State of Kansas. This effort has electronically connected many of these sites to allow the collection and analysis of patient diabetes data by KDHE personnel for improving quality of care. Over 350 health professionals participate in this program with representation from over 50% of Kansas’ counties. KDHE is an OpenHRE Contributor.

Arizona HIE Proof of Concept AMIE is a first step towards connectivity, a smaller scale "proof of concept" consisting of a federated HIE and secure web-based viewer which began on September 29, 2008 and will end September, 2009. This prototype HIE enables a targeted group of authorized AHCCCS registered clinicians to match patient demographics, locate relevant clinical information, and view individual patient documents. Because this is a federated exchange, AHCCCS does not collect or store clinical data; the HIE simply provides the means to locate and view information available from the health care facilities participating in the "proof of concept".

Big Bend RHIO: The BBRHIO is a 501.C3 not for profit Florida Corporation that aims to deliver an enhanced level of patient centered care. Surrounding rural communities will benefit from the improvements and efficiencies created by the BBRHIO efforts. Tallahassee, Florida.

HealthBridge: Southwest Ohio, North Central Kentucky and South Eastern Indiana Regions.

Indiana Health Information Exchange: The Indiana Health Information Exchange (IHIE) provides several health information exchange services throughout the state of Indiana. One of the oldest and largest health information exchanges across the country, IHIE provides a clinical messaging result delivery service and a clinical quality improvement services called Quality Health First(tm}

Jacksonville Health Information Network: The Jacksonville Health Information Network (JHIN) is one of the three complementary strategies JaxCare, Inc. is pursuing to improve the healthcare access and delivery of Jacksonville's uninsured and underinsured. The Jacksonville Health Information Network infrastructure will allow physicians and the medical staff of hospitals and clinics serving the uninsured to access the network to check for available health records in a secure manner. Jacksonville, Florida

MA-SHARE: Massachusetts SHARE (Simplifying Healthcare Among Regional Entities) is a regional collaborative initiative operated by the Massachusetts Health Data Consortium. MA-SHARE seeks to promote the inter-organizational exchange of healthcare data using information technology, standards and administrative simplification, in order to make accurate clinical health information available wherever needed in an efficient, cost-effective and safe manner.

Redwood MedNet HIE: Redwood MedNet, located in Mendocino County, California, is a community based nonprofit 501(c)(3) organization operating a clinical results delivery service in a thinly populated 5,000-square-mile (13,000 km²) rural region on the north Pacific coast.

The MidSouth eHealth Alliance: The MidSouth eHealth Alliance is a community wide information system that helps health care providers in the treatment of patients. Providers are as doctors, nurses, healthcare workers, hospitals, and clinics. The MidSouth eHealth Alliance is based in Memphis, TN.

Michiana Health Information Network: The Michiana Health Information Network is a health information exchange that support institutions and health care providers and clinicians in northern Indiana and southwestern Michigan. The mission of the exchange is the overal improvement of care and reduction of healthcare costs in the communities they serve.

University of Pittsburgh Medical Center: UPMC is an integrated healthcare delivery network that provides healthcare services to a large portion of the population in Western Pennsylvania. Incorporating an HIE solution has enabled the integration of patient data across the enterprise in addition to the flexibility of the creation and rapid deployment of enterprise wide applications that leverage integrated patient data.

Clalit Health Services / Rambam Medical Center / Sheba Medical Center: Covering more than half of Israel’s population, this HIE, operational since 2001, is one of the world’s first and most extensive HIEs. Its 16 hospitals (8100+ beds), 1300 primary and specialized clinics and 400 pharmacies, provide health services to close toover 5 million patients.

[edit] See also

• Regional Health Information Organization (RHIO)
• HL7
• DICOM
• LOINC
• Health informatics
• HealthUnity - A provider of HIE products and services.
• dbMotion - Provider of HIE, health interoperability and intelligence solutions

[edit] References

• McGowan JJ, Overhage JM, Barnes M, McDonald CJ (April 2004). "Indianapolis I3: the third generation Integrated Advanced Information Management Systems". J Med Libr Assoc 92 (2): 179–87. PMID 15098046. 
• eHealth Initiative, Second Annual Survey of State, Regional and Community-based Health Information Exchange Initiatives and Organizations, August, 2005
• Hagland, Mark (2009). Transformative Quality: The Emerging Revolution in Health Care Performance. Productivity Press/Taylor & Francis Group, LLC, New York. ISBN 978-1-4200-8492-4.

[edit] External links

• Sushoo Health Information Exchange
• Healthcare Access San Antonio (HASA)
• Bayou Teche Community Health Network (ByNet)
• CareSpark - TriCities, TN
• Eastern Kern County Information Technology Association (EKCITA)
• Kansas Department of Health and Environment (KDHE) Diabetes Quality of Care Project
• Indiana Health Information Exchange
• Jacksonville Health Information Network (JHIN)
• Indiana Network for Patient Care
• Health Information Exchange / RHIO Reference Handbook
• Mendocino HRE (Health Records Exchange)
• Arizona HIE Proof of Concept
• MA-SHARE
• eHealth Initiative
• Health Information Exchange value calculation
• Nationwide Health Information Network - Current News | NHIN Watch
• HHS Health Information Technology
• National Alliance for Health Information Technology (NAHIT)
• The Vanderbilt Center for Better Health
• Michiana Health Information Network (March 2007)
• HIMSS information about HIE and RHIO
• Standard Compliant Method for Exchanging Medical Image Data a white paper by Aware Inc.
• University of Pittsburgh Medical Center (UPMC)
• Clalit Health Services