Health information exchange

Not to be confused with Health insurance exchange (HIX).

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 and more timely, efficient, effective, and equitable patient-centered care. HIE is also useful to public health authorities to assist in analyses of the health of the population.

HIE systems facilitate the efforts of physicians and clinicians to meet high standards of patient care through electronic participation in a patient's continuity of care with multiple providers. Secondary health care provider benefits include reduced expenses associated with:

• the manual printing, scanning and faxing of documents, including paper and ink costs, as well as the maintenance of associated office machinery
• the physical mailing of patient charts and records, and phone communication to verify delivery of traditional communications, referrals, and test results
• the time and effort involved in recovering missing patient information, including any duplicate tests required to recover such information

According to an internal study at Sushoo Health Information Exchange, the current method of exchanging patients' health information accounts for approximately $17,160 of expenses annually for a single-clinician practice.

Formal organizations are now emerging to provide both form and function for health information exchange efforts, both on independent and governmental/regional levels. These organizations are, in many cases, enabled and supported financially by statewide health information exchange grants from the Office of the National Coordinator for Health Information Technology. These grants were legislated into the HITECH components of the American Reinvestment and Recovery Act in 2009. The latter 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.

In the United States, federal and state regulations regarding HIEs and HIT (health information technology) are still being defined. Federal regulations such as "Meaningful Use" legislation as well as the implementation of some state governments of state-sponsored HIEs (such as the North Carolina HIE) in addition to fluctuating health care regulations among the states are rapidly changing the face of this relatively new industry. HIEs and RHIOs continue to struggle to achieve self-sustainability and the vast majority remain tied to Federal, State, or Independent grant funding in order to remain operational; with some exceptions such as the Indiana HIE.

Established HIE communities

In the United States

Healthcare Information Exchange of New York (HIXNY)

HIXNY is a non-profit New York RHIO collaboration of hospitals, health plans, and practices spanning the Capital, Adirondack, and Mid-Hudson Valley Regions of New York State.

Chesapeake Regional Information System for our Patients (CRISP)

CRISP is a non-profit corporation that is implementing health information exchange in the state of Maryland. The organization also serves as the Health IT Extension Center for Maryland. CRISP was created by Johns Hopkins Medicine, MedStar Health, the University of Maryland Medical System and Erickson Retirement Communities. Audacious Inquiry serves as program director and technical architect for the health information exchange while Dynamed Solutions provides project management and organizational support under CRISP.

Northern Virginia Regional Health Information Organization (NoVA RHIO)

NoVA RHIO serves as the health information exchange organization for northern Virginia. The NOVA RHIO organization recently began a pilot program to ensure that electonic copies of patient medication histories are available from pharmacies in the region's emergency departments.

e-Health Network of Long Island (EHNLI)

EHNLI is a non-profit RHIO servicing eastern Nassau county and all of Suffolk County in Long Island, New York. Members include Stony Brook University Medical Center, Winthrop-University Hospital, Southampton Hospital, and other various hospitals, adult long-term care facilities, and community physicians. HealthUnity is the primary technology provider. EHNLI's headquarters are located in Stony Brook, New York.

Southern Tier HealthLink NY (STHL)

STHL is a non-profit New York RHIO designed as a partnership which brings together health care providers and consumers in central New York.

Sushoo Health Information Exchange (Sushoo)

Sushoo is an independent HIE operating on the community level in multiple states.

OpenHRE Community (OpenHRE)

OpenHRE is a consortium of communities and organizations throughout the United States utilizing the OpenHRE Toolkit, an open source software suite originally developed by Browsersoft, Inc., that was used to deploy the nation's first Multiple Health Market Health Information Exchange between Indianapolis, Boston, and Mendocino, California.

Health Monitoring Systems

Health Monitoring Systems is a private firm that connects hundreds of hospitals to public health departments throughout the United States primarily for the sake of syndromic surveillance and monitoring of regional emergency department activity.

Long Island Patient Information Exchange (LIPIX)

LIPIX is an independent, not-for-profit corporation established to develop a RHIO for Nassau county in Long Island, New York. It is headquartered in Manhasset, New York.

Healthcare Access San Antonio (HASA)

HASA is a health care consortium and OpenHRE Community Contributor serving the medically uninsured in Bexar County, Texas. Participants include the seven major safety-net hospitals, the City of San Antonio Metropolitan Health District (providing immunization data), and a network of community FQHCs (Federally Qualified Health Centers) serving the uninsured of San Antonio. The SecureShare centralized community repository contains demographic and clinical records for over 500,000 uninsured patients.

CareSpark

CareSpark is an effort underway in the central Appalachian region, including 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)

EKCITA is a rural, community-based 501.c3 not-for-profit corporation and OpenHRE Contributor in Southern California. It has enabled sharing of electronic health files and clinical data for public health, patient care, and research purposes. The EKCITA deployment provides community caregivers access to over 32,000 local patient health profiles.

Bayou Teche Community Health Network (ByNet)

ByNet is a non-profit, rural health network and OpenHRE Contributor in Franklin, Louisiana, comprising 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.

Medical Information Network – North Sound (MIN-NS)

The Medical Information Network - North Sound is a Washington state-based HIE consisting of three members: Skagit Valley Hospital, Island Hospital, and United General Hospital.

Kansas Department of Health and Environment (KDHE) Diabetes Quality of Care Project

The KDHE Diabetes Quality of Care Project involves over 68 funded organizations at 90 provider sites across 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 the state's counties. KDHE is an OpenHRE Contributor.

Big Bend RHIO (BBRHIO)

The BBRHIO is a 501.c3 not-for-profit Florida Corporation headquartered in Tallahassee, Florida.

Idaho Health Data Exchange (IHDE)

The IHDE is a 501(c)(6) non-profit corporation established to govern the development and implementation of a health information exchange in Idaho, as a result of the efforts of the Health Quality Planning Commission, which was created by the 2006 legislature. It is governed by a Board of Directors and includes representation from both the public and private sectors, including the health care delivery and financing systems, health care providers, Idaho Employer Coalition, and consumers.

HealthBridge

HealthBridge serves the Southwest Ohio, North Central Kentucky, and South Eastern Indiana regions.

Indiana Health Information Exchange (IHIE)

The IHIE provides several health information exchange services throughout the state of Indiana. It provides a clinical messaging result delivery service and a clinical quality improvement service called Quality Health First.

New England Healthcare Exchange Network (NEHEN)

NEHEN, headquartered in Waltham, Massachusetts, is a 501.c3 organization with more than thirty five member organizations. Founded in 1998, it initially focused on payor/provider information exchange. After merging with MA-SHARE (Simplifying Healthcare Among Regional Entities, a regional collaborative initiative operated by the Massachusetts Health Data Consortium) in June, 2009, NEHEN now offers electronic prescribing support and clinical information exchange to its members as well as healthcare administrative transaction support.

Redwood MedNet

Redwood MedNet, located in Mendocino County, California, is a community-based 501(c)(3) nonprofit 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. It is based in Memphis, Tennessee.

Michiana Health Information Network (MHIN)

The MHIN is a health information exchange that supports institutions and health care providers and clinicians in northern Indiana and southwestern Michigan.

University of Pittsburgh Medical Center (UPMC)

UPMC is an integrated healthcare delivery network that provides healthcare services to a large portion of the population in Western Pennsylvania.

Wisconsin Health Information Exchange (WHIE)

Western Health Information Network (WHIN)

The WHIN (formerly Long Beach Network for Health) is an independent, community-based not-for-profit corporation operating a regional HIE for Southern California. It is headquartered in Long Beach, California.

MedVirginia

MedVirginia Solution is an HIE serving central Virginia.

U.S. Department of Veteran's Affairs and the Department of Defense (VA and DoD)

The VA and DoD have several very large health information exchange projects including FHIE, BHIE, CHDR, and VLER.

Outside of the United States

Clalit Health Services / Rambam Medical Center / Sheba Medical Center

Covering more than half of Israel’s population, this HIE has been operational since 2001. The HIE includes 16 hospitals (with over 8,100 beds), 1,300 primary and specialized clinics, and 400 pharmacies, and collectively provides health services to close to 5 million patients.

See also

• DICOM (Digital Imaging and Communications in Medicine)
• LOINC (Logical Observation Identifiers Names and Codes)
• Health informatics
• Health Level 7 (HL7)
• Integrating the Healthcare Enterprise (IHE)
• Medical imaging
• Regional Health Information Organization (RHIO)

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. PMC 385298. PMID 15098046. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=385298. 
• 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.

External links

• HHS Health Information Technology
• HIMSS information about HIE and RHIO