Across the country, health information exchange (HIE) technology priorities are evolving rapidly as patients, providers, and payers better understand the multiple benefits and requirements associated with information sharing and data aggregation for both individual patient care and population health. The role of data is critical in key initiatives of interest to providers managing patients in traditional care settings as well as coordinating care across the community and to patients as they seek to better understand and participate in their own care.
Historically—especially in the last ten years—HIEs have dealt with myriad challenges to gain adoption in their ecosystems. Early on, many electronic health record (EHR) systems were not ready to connect to an HIE. Similarly, many organizations migrated to new EHRs, which took time and, in some cases, delayed adoption of an HIE. Other challenges faced by HIEs were dealing with potential participant and patient concerns about patient privacy, and payer and provider information being potentially accessible to each other. Some HIEs have been strongly supported by their stakeholders, including state health departments and Medicaid agencies, while others have struggled to gain this support.
The new reality for HIEs is that they are now grappling with the implications of being a part of a national network of networks due to the Trusted Exchange Framework and Common Agreement (TEFCA) while trying to achieve sustainability for their business.
Some HIEs have responded to TEFCA and other new data sharing initiatives by joining the eHealth Exchange, a national query-based network that connects federal and non-federal organizations in all 50 states—enabling connectivity between their stakeholders and participants of the eHealth Exchange, including CommonWell and Carequality participants. Many HIEs have also joined the Strategic Health Information Exchange Collaborative’s (SHIEC) Patient Centered Data Home (PCDH) initiative, which is an admission discharge transfer (ADT) notification system between PCDH participants.
Participating in these national initiatives while continuing to add value at “home” for their participants, including state government agency participants, is exactly where HIEs need to focus.
How HIEs are Achieving Sustainability
Common steps by successful HIEs include providing a public health gateway to state health department labs for participants to exchange immunization, electronic lab, and cancer case reporting data. Additionally, successful HIEs are providing essential syndromic surveillance data feeds to support COVID-19 responses by state and local officials.
A community record, accessed typically in a clinical or provider portal, is a longstanding feature of HIEs, allowing providers access to allergies, medications, encounters, lab results, and other essential clinical and (sometimes) claims data from data sources throughout the HIE ecosystem. Some HIEs are connected to state prescription drug monitoring programs, allowing providers access to essential information while minimizing the number of clicks required to obtain it.
Making access to the HIE as seamless as possible, such as allowing providers to stay in their existing EHR workflow, is another way HIEs can ensure successful adoption. This can be accomplished through single-sign-on or API calls from EHRs to HIEs (or vice-versa), an emerging trend among successful HIEs and their participants.
A tremendous asset for HIEs to consider is allowing their participants to access (or query) the eHealth Exchange via the HIE community record. For non-traditional HIE participants such as dentists, optometrists, and chiropractors, this enables access to very important information related to the treatment of their patients.
An additional approach HIEs may wish to consider is leveraging tools or modules already embedded in their HIE technology—such as an electronic master patient index, record locator service, event/ADT notification systems, or provider directory tools—to provide essential shared services between HIEs or other stakeholders in their state or region. With the increased focus on how HIEs can support state agencies, adding value to Medicaid or a state health department can move an HIE much closer to sustainability.
The Technology and Data Needs for the Next Generation of HIEs
Interviewing stakeholders and creating short- and long-term plans should be on the to-do list of all HIE leaders and advisory committee members as HIEs look to update their strategies to respond to changes in the industry and achieve long-term suitability. By evaluating what’s been successful and what’s been a struggle, HIEs will be better poised to respond to future challenges and understand what the impact of the 21st Century Cures Act, TEFCA, and other recent mandates will have on the HIE and its participants.
After evaluating their strategies and previous strengths and weaknesses, HIEs should then look at the technology. With an open and scalable platform for population health, HIEs can deliver a comprehensive approach to acquiring, enriching, analyzing, and presenting actionable clinical and claims data, as well as non-traditional data (e.g., social determinants of health data). With an open and scalable platform, HIEs have a solid foundation to execute population health management programs and support new and emerging value-based care models while also preparing for precision medicine.
HIEs should be attempting to expand access to additional valuable real-time medication data and implementing new reporting tools to proactively monitor patients’ medication management and adherence. HIEs are identifying the link between interoperable technology and improved healthcare quality to advance the adoption and use of technology to exchange health information and improve healthcare quality, patient safety, and overall efficiency of healthcare and public health services across the US.
A secure statewide medical record sharing network for providers and consumers simplifies the medical record sharing process, creating a data roadmap for a more thorough understanding of patients’ conditions, allowing for up-to-the-minute decisions and faster diagnoses. This will help reduce patient intake time, minimize duplicate tests and paperwork, and give providers more one-on-one time with patients.
With an open data platform, providers can make more informed care decisions, improve the coordination of care across the healthcare continuum, and, ultimately, drive better healthcare outcomes.
Providers can also seamlessly share, view, and receive patients’ immunization records, medication lists, histories, discharge summaries, lab results, and radiology reports as well as share referrals electronically through the HIE’s open data platform.
What Comes Next?
It all sounds simple, right? HIEs need to continue to evolve to serve their stakeholders and patients within their ecosystem. This means engaging with national networks and being interoperable with an ever-growing number of sharing partners, all while working on changing sustainability models and mandatory requirements.
Success will come when HIEs listen to their stakeholders and identify use cases that can benefit from the HIE or a network of networks approach to solving problems for an ecosystem. By using a short- and long-term planning approach and staying engaged with regional and national trends, HIEs can then utilize their technology stacks to best serve their state or region well into the future. With a solid technology foundation in place to meet today’s population health, medication management, and care coordination needs, HIEs will be prepared to tackle tomorrow’s healthcare challenges. Chad Peterson is vice president, public sector at Orion Health.
Continuing Education Quiz
Review quiz questions and take the quiz based on this article, available online.
- Quiz ID: Q2049107
- Expiration Date: July 1, 2021
- HIM Domain Area: Informatics, Analytics and Data Use