Health information exchange

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

Health information exchange (HIE) is the mobilization of health care information electronically across organizations within a region, community or hospital system. In practice the term HIE may also refer to the organization that facilitates the exchange.

HIE provides the capability to electronically move clinical information among different health care information systems. 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[citation needed], the current[when?] method of exchanging patients' health information accounts for approximately $17,160 of expenses annually for a single-clinician practice.

Formal organizations are now[when?] emerging to provide both form and function for health information exchange efforts, both on independent and governmental or 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.[1] 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.[2]

In the United States, federal and state regulations regarding HIEs and HIT (health information technology) are still being defined. Federal regulations and incentive programs such as "Meaningful Use", which is formally known as the EHR Incentive Program,[3][4] are rapidly changing the face of this relatively new industry. In addition to changes driven by federal activities, the lessons learned in the ongoing implementation of some state-sponsored HIEs (such as the North Carolina HIE[5]) and the fluctuating nature of health care regulations at the level of the state governments themselves are leading to additional refinement. However, 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. Some exceptions exist, such as the Indiana HIE.[6][7]

Storage and gathering of information[edit]

Data architecture models[edit]

There are two main models for the data architecture of health information exchanges. One is a federated, or decentralized model, and the second is a centralized one. There is also a hybrid model that contains elements of both. In a centralized HIE there is a central (or master) database which holds a complete copy of all of the records of every patient contained in the HIE. In a federated HIE there is no master database.

In a federated model each health care provider is responsible for maintaining the records of their individual patients. In this model the main function of the HIE is to facilitate providers with exchanging patient records among themselves as the need arises. For example, if a physician in a federated HIE requests the records of Patient Y a query is sent to each server in the system asking to return any records that they have pertaining to Patient Y. Each federated HIE may accomplish this in a slightly different way, but the salient distinction is that in a federated model there is no central database from which a previously compiled comprehensive medical record is stored and can be downloaded.

In short, in a federated HIE records are exchanged electronically among providers when they need them. In a centralized model all patient information is uploaded to a single database from which any provider in the HIE can download a patient's full medical record.[8][9]

Patient consent[edit]

Exchanges in the US must operate with patient consent to comply with not only the Health Insurance Portability and Accountability Act (HIPAA), but a variety of state and federal laws and regulations. This was clarified by the Office of Civil Rights in the January 2013 Final Omnibus Rule Update to HIPAA.[10]

There are two methods for gaining patient consent. One is explicit consent and is termed opt-in. With this method a patient is not automatically enrolled into the HIE by default and generally must submit a written request to join the exchange.

The other method is implicit patient consent and is termed opt-out. In this method patients give implicit consent to join an HIE when they agree to use the services of a health care provider who is submitting data into an HIE and sign the provider's Notice Of Privacy Practices. In this model patients can request to opt out of the HIE, generally with a written form.[11]

List of United States health information exchanges[edit]

State Name Oversight agency
Alabama Alabama Medicaid HIE Alabama Medicaid Agency
Florida Health Information Exchange Florida Agency for Healthcare Administration
Georgia Health Information Network Georgia Department of Community Health
One Health Record Alabama Alabama Medicaid Agency
Alaska Alaska eHealth Network State of Alaska Department of Health and Social Services
American Samoa American Samoa Health Information Exchange American Samoa Dept of Health
Arizona Arizona Health E Connection Arizona Governor’s Office of Health information Exchange
Behavioral Health HIE Arizona Governor’s Office of Health information Exchange
Arkansas SHARE Arkansas Office of Health Information Technology
California Brown & Toland Medical Group California Office of Health Information Integrity
CAReHIN State of California Office of Health Information Integrity
Cal Index State of California Office of Health Information Integrity
Central Coast Health Connect State of California Office of Health Information Integrity
Connect Healthcare State of California Office of Health Information Integrity
Dignity Health State of California Office of Health Information Integrity
E Health California State of California Office of Health Information Integrity
Healthcare Partners State of California Office of Health Information Integrity
Hill Physicians State of California Office of Health Information Integrity
HOAG HIE State of California Office of Health Information Integrity
Huntington Hospital State of California Office of Health Information Integrity
Inland Empire HIE State of California Office of Health Information Integrity
John Muir Health State of California Office of Health Information Integrity
Kaiser Permanente State of California Office of Health Information Integrity
LANES LA State of California Office of Health Information Integrity
Memorial Healthcare System State of California Office of Health Information Integrity
North Coast Health Information Network State of California Office of Health Information Integrity
One California Partnership Regional Health Information Organization State of California Office of Health Information Integrity
Palo Alto Medical Foundation State of California Office of Health Information Integrity
RAIN-Live Oak State of California Office of Health Information Integrity
Redwood Mednet State of California Office of Health Information Integrity
Sac Valley Medshare State of California Office of Health Information Integrity
St. Joseph Health System State of California Office of Health Information Integrity
San Diego Health Connect State of California Office of Health Information Integrity
San Joaquin Community HIE State of California Office of Health Information Integrity
San Francisco General Hospital State of California Office of Health Information Integrity
San Mateo Medical Center State of California Office of Health Information Integrity
Santa Cruz HIE State of California Office of Health Information Integrity
Sharp Healthcare State of California Office of Health Information Integrity
Sutter Health State of California Office of Health Information Integrity
Tulare Kings Foundation for Medical Care State of California Office of Health Information Integrity
Vigilance Health State of California Office of Health Information Integrity
Colorado CORHIO Colorado Regional Health Information Organization
Quality Health Network Colorado Regional Health Information Organization
Connecticut Western Connecticut Health Network State of Connecticut Department of Public Health
ERICCA State of Connecticut Department of Public Health
Delaware DHIN Delaware Health Information Network
District of Columbia CRISP District of Columbia Department of Health
Florida Florida HIE Florida Agency for Health Care Administration
Memorial Healthcare System
University of Florida Health
Strategic Health Intelligence
Broward Health
Bethesda Health
Tampa Bay HIE
Florida Hospital/Adventist
Community Health IT - MyHealthStory
Florida Accountable Care Services
Senior Home Care
Georgia ArcHIE Georgia Department of Community Health
Chatham County Safety Net Planning Council Georgia Department of Community Health
GA Telehealth Georgia Department of Community Health
Georgia Health Information Network Georgia Department of Community Health
GracHIE Georgia Department of Community Health
HealtheConnection Georgia Department of Community Health
West Georgia Health System Georgia Department of Community Health
Guam Guam HIE Guam Departmentof Health
Hawaii HHIE Hawaii Health Information Exchange
Idaho IHDE Idaho Health Data Exchange
Illinois Illinois Health Information Exchange (ILHIE) Illinois Department of Healthcare and Family Services
Indiana HealthBridge Inc. Indiana Health Information Technology
HealthLINC Inc. Indiana Health Information Technology
Indiana Health Information Exchange Inc. Indiana Health Information Technology
Michiana Health Information Network, LLC Indiana Health Information Technology
Iowa Iowa Health Information Network (IHIN) Iowa Department of Public Health
Kansas Kansas Health Information Network Kansas Department of Health and Environment
Lewis & Clark Information Exchange (LACIE) Kansas Department of Health and Environment
Kentucky Kentucky Health Information Exchange Cabinet for Health and Family Services
Louisiana LaHIE Louisiana Health Care Quality Forum
Maine HealthInfoNet Maine Office of Health and Policy Finance
Maryland CRISP The Maryland Department of Health and Mental Hygiene
Massachusetts Mass HIway Massachusetts eHealth Institute (MeHI)/Massachusetts eHealth Collaborative (MAEHC)
Michigan Administrative Network Technology Solutions(ANTS) Michigan Department of Health
Great Lakes Health Connect(GLHC) Michigan Department of Health
Henry Ford Health System (HFHS) Michigan Department of Health
Ingenium Michigan Department of Health
Jackson Community Medical Record (JCMR) Michigan Department of Health
Michiana Health Information Network (MHIN) Michigan Department of Health
Northern Physicians Organization (NPO) Michigan Department of Health
Patient Ping Michigan Department of Health
PCE Systems Michigan Department of Health
Southeast health Information Exchange (SEMHIE) Michigan Department of Health
Upper Penninusla Health Information Exchange (UPHIE) Michigan Department of Health
Minnesota Emdeon Minnesota Department of Health
Mississippi Mississippi Health Information Network Mississippi Department of Health
Missouri Lewis & Clark Information Exchange (LACIE) Missouri Department of Social Services
Missouri Health Connection Missouri Department of Social Services
Tiger Institute Health Alliance Missouri Department of Social Services
Montana HealthShare Montana Montana Designated Health Information Exchange Organization
Nebraska Nebraska Health Information Initiative Nebraska Department of Administrative Services
Nevada HealtHIE Nevada HealthInsight Nevada
New Hampshire NHHIO New Hampshire Health Information Organization
New Jersey Camden Coalition New Jersey Health Care Facilities Financing Authority
Health-e-cITi New Jersey Health Care Facilities Financing Authority
Jersey Health Connect New Jersey Health Care Facilities Financing Authority
New Jersey HiTec New Jersey Health Care Facilities Financing Authority
New Mexico New Mexico Health Information Connection (NMHIC) LCF Research, New Mexico
New York Bronx RHIO New York eHealth Collaborative
Health e Connections New York eHealth Collaborative
Health Information New York New York eHealth Collaborative
Healthix New York eHealth Collaborative
HEALTH e LINK New York eHealth Collaborative
Healthlink NY New York eHealth Collaborative
Rochester NY RHIO New York eHealth Collaborative
Southern Tier Health Link New York eHealth Collaborative
North Carolina Coastal Connect Health Information Exchange North Carolina Department of State Treasurer
North Carolina HIE North Carolina Department of State Treasurer
Western North Carolina Data Link North Carolina Department of State Treasurer
North Dakota North Dakota Health Information Network State of North Dakota, Dept. of Information Technology
Northern Mariana Islands N/A Commonwealth of the Mariana Islands
Ohio CliniSync Ohio Health Information Partnership
Greater Dayton Area HIN
HealthBridge Healthcare Collaborative of Cincinnati
Oklahoma Coordinated Care Oklahoma (CCO) Oklahoma Health Care Authority
My Health Access Network Oklahoma Health Care Authority
Oregon Care Accord Oregon's State Information Exchange State of Oregon Health Authority
Pennsylvania HealthShare Exchange of Southeastern PA Pennsylvania e Health Authority
Keystone Health Information Exchange (KeyHIE) Pennsylvania eHealth Authority
Puerto Rico Puerto Rico Health Information Network La Fortaleza Oficina del Gobernador
Rhode Island Rhode Island Quality Institute (CurrentCare) Rhode Island Dept. of Health
South Carolina South Carolina Health Information Exchange (SCHIEx) South Carolina Department of Health & Human Services
South Dakota Sount Dakota Health Link South Dakota Department of Health
Tennessee East TN Health Information Network State of TennesseeOffice of eHealth Initiatives
MidSouth eHealth Alliance State of TennesseeOffice of eHealth Initiatives
Texas First Net Texas Health and Human Services Commission
Greater Houston Healthconnect Texas Health and Human Services Commission
Healthcare Access San Antonio Texas Health and Human Services Commission
Health Informationm of South Texas Texas Health and Human Services Commission
HIE Texas Texas Health and Human Services Commission
Pasa Del Norte Health Information Exchange Texas Health and Human Services Commission
Rio Grand HIE Texas Health and Human Services Commission
Rio One HIE Texas Health and Human Services Commission
SETHS Operated Provider HIE Texas Health and Human Services Commission
U.S. Virgin Islands N/A Virgin Islands Department of Health
Utah Utah Health Information Network (UHIN) Utah Department of Health
Vermont Vermont Information Technology Leaders Inc. (VITL) Vermont Department of Human Services
Virginia Connect Virginia Virginia Department of Health
Washington OneHealthPort HIE Washington Healthcare Authority
North Shore Medical Group Washington Healthcare Authority
Skyline Hospital Washington Healthcare Authority
West Virginia West Virginia Health Information Network (WVHIN) West Virginia Department of Health and Human Services
Wisconsin WISHIN Pulse Wisconsin Department of Health Services
Wyoming Wyoming e-Health Partnership State of Wyoming Office of the Governor
Chesapeake Regional Information System for our Patients
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.[12] Audacious Inquiry, a health information system consulting firm, serves as the technical architect and strategic partner for the health information exchange while Dynamed Solutions provides operational, project management and organizational support under CRISP.
CORHIO - the Colorado Regional Health Information Organization
CORHIO is one of the United States' largest public health information exchange networks and the state designated entity for HIE in Colorado.[13] As of November 1, 2014, 38 Colorado hospitals and more than 2,200 doctors, and 130 long-term and post-acute care centers were connected to the CORHIO HIE.[14][15]
Delaware Health Information Network
DHIN is a non-profit public-private partnership enacted by the Delaware General Assembly in 1997, for the benefit of all citizens of Delaware to advance the creation of a statewide health information network and to address Delaware's needs for timely, reliable and relevant health care information. DHIN has adopted regulations to govern its operations and has policies and procedures in place to support privacy and security of patient information. DHIN enhances a health care information exchange started in May 2007. In February 2012, The Delaware Health Information Network announced full participation of all acute care hospitals and skilled nursing facilities in the state, along with the vast majority of Delaware providers, in the first statewide community health record. As of June 2013, DHIN has attracted the participation of 97 percent of Delaware providers, tracks nearly 88 percent of Delaware's population, and delivers more than 10 million clinical results and reports to participating providers annually.[16]
Frysian Health Information Exchange
The Friesland Regional Cardiology Network speeds up the referral process, improves both diagnosis and the clinical decision process, and on average reduces by one or two days the length-of-stay for patients in hospitals. From their office workstations, cardiologists are able to consult the advanced clinical images provided by any hospital linked to the network. The distributed storage of records eliminates the duplication of records across multiple sites. Once uploaded to the cardiology network, records remain available for consultation at any time so that previous episodes of a patient’s care can be consulted in detail no matter where the care was provided in the region.
Great Lakes Health Connect
Great Lakes Health Connect (GLHC), based in Grand Rapids, is the largest provider of Health Information Exchange (HIE) services in Michigan. GLHC was founded in 2009 as Michigan Health Connect (MHC) when several health systems in West Michigan (including Spectrum Health, Trinity Health, Metro Health, Lakeland Health, and Northern Michigan Regional Health System) agreed to collaborate and not compete on clinical data exchange. In March of 2010 MHC was formally launched as a charitable [509(a)2] non-profit corporation in Michigan. In June of 2014 Michigan Health Connect merged with Great Lakes Health Information Exchange (GLHIE) to form Great Lakes Health Connect. Today, GLHC is among the leading providers of health information exchange services in the nation. GLHC seamlessly and securely facilitates the transmission of more than a billion messages a year across 129 health systems and nearly 4,000 primary, secondary and allied care provider offices across the state. The community-based nonprofit is dedicated to improving the quality and accessibility of healthcare information by creating care-connected communities across Michigan and beyond.
Harvard Pilgrim Health Care
HPHC is a non-profit insurance provider which serves members throughout Massachusetts, New Hampshire, and Maine. The provider offers variety health insurance options for companies, families and individuals. Customers health insurance expectations are met through a tailored options from preferred provider organization (PPO), point-of-sale (POS), and health maintenance organization (HMO). HPHC implements CRM, Master Data Management and is now implementing Oracle Policy Automation to support integrated call center and online self-service for plan purchase and management across their various customer groups additionally, HPHC is using their platform to support recruitment and to better analyze and improve service levels in a heavily competitive market.[17]
HealthShare Exchange of Southeastern PA
HSX is a unique, membership-dues-supported nonprofit formed by the Delaware Valley’s hospitals/health systems and healthcare insurers. It makes electronic patient-care information available securely throughout the area’s medical system, linking data across hospital systems and healthcare insurers as a service to HSX members and participants. The HSX platform allows medical centers, insurers, and practice offices to share clinical records to make patient care more informed — by providing patient histories and event notifications throughout the system. Such exchange is part of the health information future for providers, payers, and consumers seeking better, more cost-effective care. It promotes continuity of care, reduces the need to transmit or transport medical information by patients or by fax, and helps to reduce duplicate services.
Idaho Health Data Exchange
The Idaho Health Data Exchange (IHDE) is the state designated Health Information Exchange (HIE) for Idaho. Health Information Exchange enables doctors, nurses, labs, and other medical providers to securely access their patient’s electronic health information quickly, 24/7/365, to improve the speed, quality, safety, and cost of patient care. IHDE is a non-profit 501(c)(6) company. The IHDE is Idaho created, based, and managed. Located in Boise, ID, the staff consists of an Executive Director, Executive Assistant, Sr. Marketing Coordinator, Business Analysts (Implementations), Training/Support Specialists, and IT systems support. The IHDE’s mission is to create, and maintain a collaborative effort to improve the coordination and quality of healthcare through the use of Health Information Exchange and Health Information Technology. The IHDE is governed by a voluntary Board of Directors and voluntary Privacy and Security Committee which provides oversight of compliance and best practices. Members of the Board of Directors and Privacy and Security Committee represent the private and public sectors, and health care delivery systems, with a passionate interest in Health Information Exchange.[18]
Indiana Health Information Exchange
The Indiana Health Information Exchange (IHIE) operates the U.S.'s largest HIE and one of the oldest with data on more than 7 million patients, connecting hospitals, rehabilitation centers, long term care facilities, laboratories, imaging centers, clinics, community health centers and other healthcare organizations. Created by the Regenstrief Institute, a medical informatics think tank, the Indiana Network for Patient Care (INPC) is a secure network that provides a patient records to participating doctors. The IHIE provides current data about admissions, discharges, and transfers to help health plans and accountable care organizations reduce nonurgent emergency department visits.[19] This HIE grew over time from 12 hospitals in the center of the state with approximately 5,000 physicians, to 106 hospitals out of 126 in the state and more than 14,000 physicians in Indiana.[20]
Keystone Health Information Exchange
KeyHIE was founded by Geisinger Health System in April 2005, via a memorandum of understanding signed by 8 hospitals throughout Central Pennsylvania. One of the nation’s largest and most advanced health information exchanges, KeyHIE connects 18 hospitals, 251 physician practices, 95 long-term care facilities, 30 home health agencies and other healthcare organizations such as EMS agencies, pharmacies, and federally qualified health centers (FQHCs). It serves 4.3 million patients over a 53-county presence in Pennsylvania to ensure health information follows patients, regardless of where they receive care. KeyHIE offers a wide range of services to doctor’s offices, hospitals, nursing homes and other healthcare organizations in Pennsylvania and surrounding areas.
Michiana Health Information Network
MHIN is one of the first HIEs in the United States and offers unprecedented levels of integration and connectivity to healthcare professionals and providers. In 1998, MHIN was incorporated, and the team went right to work improving, securing, and facilitating communication among providers. Today, MHIN continues to assist communities throughout the Midwest to establish a regionally based HIE. Organizations across the healthcare spectrum - from hospitals to specialty groups to medical labs and diagnostic centers - find solutions in MHIN's diverse service platform. MHIN's core applications provide an efficient, secure way for providers to exchange information and facilitate high-quality, coordinated care.
Missouri Health Connection
Missouri Health Connection(MHC) is a nonprofit organization that operates Missouri's statewide health information network. Established in 2009, MHC's mission is to enable Missouri healthcare providers-from small, rural clinics to large hospital systems-to securely share a patient's medical data. With our wide network of hospitals, clinics, and community health centers, MHC's network will connect inpatient and outpatient care in Missouri. MHC's network covers two-thirds of the inpatient care in Missouri and enables physicians to access more complete patient records.
MHC provides the technological infrastructure for health care providers to coordinate care for their patients through a secure health information network.The services provided by MHC are designed to support all health care provider organizations, from the largest multi-hospital health system to a solo physician practice. Coordinating care, reducing preventable errors, and avoiding treatment duplication are among MHC’s primary goals. MHC’s network will improve patient care and help save lives in emergencies by securely delivering more complete and accurate information at the point of care, or wherever it is needed. MHC is a non-profit 501(c)(3) organization and is governed by a board of directors that includes representatives from both public and private organizations such as hospital systems, health care providers, state agencies and consumer groups.
Ohio Health Information Partnership
CliniSync HIE
The Ohio Health Information Partnership, a nonprofit, public/private partnership initially funded with $14.8 million in federal HITECH funds under the Office of the National Coordinator for HIT, is the state-designated statewide health information exchange founded by the Ohio State Medical Association, the Ohio Osteopathic Association,the Ohio Hospital Association, BioOhio and the Ohio Department of Insurance.
Federal funds paid for the creation of the technological infrastructure, powered by Medicity, as well as discounted implementation fees for hospitals in Ohio. The CliniSync Health Information Exchange has 149 hospitals contracted to join the network. CliniSync now has 122 hospitals "live" on the network with thousands of physicians receiving results and reports directly from live hospitals or waiting to do so when hospitals go live.
The CliniSync HIE continues to grow each day, with more and more physicians connecting. In 2015, CliniSync enabled practices and other authorized users to look up and find (query and retrieve) a longitudinal Community Health Record on a patient that gives clinician a full picture of a patients health, including recent visits to various hospitals hospital, allergies, tests and reports, care summaries and other useful information. Patients in Ohio automatically are enrolled in the CliniSync HIE unless they wish to opt out.

Along with results and reports delivery and the Community Health Record, CliniSync members will receive notifications when a patient is discharged or admitted to the hospital or Emergency Department in late 2016. The CliniSync base has extended to 400 plus long-term and post-acute care facilities, behavioral health facilities, and even to social service agencies whose patients need the resources of the community beyond medical care. The nonprofit is now fiscally independent of any federal funds. CliniSync's website is www.clinisync.org.

Pennsylvania eHealth Partnership Authority
Taking over the work of the PA eHealth Collaborative, the Pennsylvania eHealth Partnership Authority (PAeHealth) provides leadership and strategic direction for public and private, federally funded and state-funded investments in health information technology initiatives, including health information exchange capabilities and other related health information technology efforts. The Authority’s direction has considered the stakeholder community's needs and will complement commonwealth agency operations. It also will ensure ongoing interagency cooperation.
Utah Health Information Network
The Utah Health Information Network (UHIN) is a broad-based coalition of Utah healthcare insurers, providers, and other interested parties, including the Utah State government. Since 1993, UHIN members have come together for the common goal of reducing healthcare costs and improving the quality of care through the use of electronic data interchange (EDI) for healthcare transactions. Exchanging information electronically rather than by phone, fax or surface mail means that data can get to those who need it securely, economically and efficiently. UHIN currently serves nearly all the hospitals, ambulatory surgery centers, national laboratories, insurers, and approximately 90% of the medical providers in Utah as well as the Utah State government. As a community organization the focus is on creating data exchange solutions that work for the entire healthcare community, from large integrated networks to single-provider offices. The Clinical Health Information Exchange (cHIE) is a secure electronic way for medical professionals to share and view patient information that is needed at the point of care. The cHIE makes this information accessible, with patient consent, to authorized users while maintaining the highest standards of patient privacy.

See also[edit]

References[edit]

  1. ^ "Archived copy". Archived from the original on February 9, 2011. Retrieved December 23, 2010. 
  2. ^ Overhage JM, Evans L, Marchibroda J (2005). "Communities' readiness for health information exchange: the National Landscape in 2004". J Am Med Inform Assoc. 12 (2): 107–12. doi:10.1197/jamia.M1680. PMC 551542free to read. PMID 15561785. 
  3. ^ EHR Incentive Program
  4. ^ "Archived copy". Archived from the original on April 20, 2010. Retrieved April 21, 2010. 
  5. ^ http://www.nchica.org/GetInvolved/NCHIE/intro.htm
  6. ^ "Home - Indiana Health Information Exchange". ihie.org. Retrieved 13 April 2016. 
  7. ^ McGee, Marianne. "8 Health Information Exchanges Lead The Way". Information Week. Retrieved 10 June 2012. 
  8. ^ http://www.himss.org/files/HIMSSorg/content/files/2009HIETechnicalModels.pdf
  9. ^ HIMSS information about HIE and RHIO
  10. ^ http://www.ama-assn.org/resources/doc/washington/hipaa-omnibus-final-rule-summary.pdf
  11. ^ http://dss.mo.gov/hie/leadership/pdf2010/optin_vs_optout_overview.pdf
  12. ^ Sentementes, Gus G. (2009). "Md. takes lead in electronic medical records". Retrieved 2009-11-26 
  13. ^ "Corhio Awarded 9.175 Million To Build Out A Statewide Health Information Exchange". 2010-02-16. Retrieved 2013-01-03. 
  14. ^ "CORHIO - Home". corhio.org. Retrieved 13 April 2016. 
  15. ^ "Colorado Regional Health Information Organization's network helps doctors find patients information - Staying Healthy Story". 7NEWS, Denver. 2012-12-21. Retrieved 2013-01-03. 
  16. ^ "Statewide Health Information Exchange Generates High Levels of Participation and Many Reports of Improved Quality and Efficiency". Agency for Healthcare Research and Quality. 2013-06-05. Retrieved 2013-06-06. 
  17. ^ oracle iGovernment (2011). "Getting ready for 2014: Oracle's Best Practices for Integrating Health Reform and Human Services Initiatives" (PDF). 
  18. ^ IHDE (2014). "IHDE". 
  19. ^ "Statewide Health Information Exchange Provides Daily Alerts About Emergency Department and Inpatient Visits, Helping Health Plans and Accountable Care Organizations Reduce Utilization and Costs". Agency for Healthcare Research and Quality. 2014-01-29. Retrieved 2014-01-29. 
  20. ^ "Trends in Health Information Exchanges: A Conversation With J. Marc Overhage, MD, PhD, Chief Medical Informatics Officer at Siemens Healthcare, Health Services". Agency for Healthcare Research and Quality. 2013-06-05. Retrieved 2013-06-06. 

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