By Chris Hobson, MD, and Allen Ausford, MD, FCFP
Like all aspects of the healthcare system, the day in the life of a primary care provider has evolved. Today, providers integrate many different technologies and tools into their practice to deliver care to enhance the experience for both themselves and their patients. These systems also help to tackle modern-day challenges. How do providers choose among these systems?
Over the last decade, health information exchanges (HIEs) have become a central part of many provider practices to electronically facilitate the secure exchange of a patient’s medical information across organizations. The value of HIEs continues to evolve and be more realized across the health system.
From a provider perspective, what value does an HIE bring?
How HIEs Lead Providers to Better Guide Care Decisions
Today’s clinical digital world incorporates several new concepts, including the new professionalism around the use of technology and sharing of information. The patient-centered medical home, a care delivery model whereby patient treatment is coordinated through the primary care physician, contributes to enhanced information sharing and improved facilitation of team-based care.
HIEs offer a broader picture of the patient’s health in the following ways:
HIEs improve the completeness of patient records, as all providers have access to review and update the same data. They offer a patient-centric view rather than a provider/organization-centric view, which can help to establish a partnership among the provider, patient, their family, and their care circle to align decisions with the patient’s medical needs and preferences. HIEs can help to avoid repetitive testing and procedures for patients by ensuring the results are captured in a centralized location where all providers can access them. Providers can also see consultant reports within the HIE and aggregate clinical decision support. HIEs also offer access to broader data, such as community data. An example is the Alberta Community Information Integration (CII) project, which posts information from local electronic health records (EHRs) to the HIE, thereby improving continuity of care across the health system through better access to primary care and community health information. HIEs can also help share important patient insight to guide care decisions through team-based care, including access to the circle of care (who is involved with this patient), facilitating care coordination, referrals (including virtual referrals for advice or full in-person consults), shared worklists, and managing chronic disease. HIEs can also link out to knowledge bases such as problem lists, common links, decision tools including clinical practice guidelines, order sets, care pathways, and more. Additional insights can come from patient-generated data gathered via tools such as a patient portal, which allows the patient to become a true member of their care team and provides insights that can help to guide better care decisions.
Why There Shouldn’t Be Any Hesitancy to Join and Use an HIE Data Network
HIEs have matured over time and are now viewed as a trusted source, including trust in the data and trust in the organization backing the HIE. They are performant, easy to use, and follow a simpler workflow than an EHR. Savvy providers leverage their HIE anytime they need information beyond their local realm.
Among providers, the new professionalism is sharing information. In fact, in some regions, if you don’t share data, you could be fined as outlined in the information blocking rule. In today’s age, organizations, governments, and patients share and allow access to information in a secure manner.
HIEs are equipped with privacy and security certifications and protocols to support organization compliance with industry standards, as there are practices in place to ensure clinical integrity and safety of the data.
HIE-hesitant providers often express concerns that utilizing an HIE will consume more time. While this is occasionally true with some patient encounters, it is important to look at the bigger picture. For one encounter, it may be an additional step to access the HIE, but it may prevent the need for a second encounter or prevent a referral from being rejected. Another point is that the provider doesn’t necessarily go to the HIE for every encounter, as they often go in a targeted fashion, depending on the patient’s presentation. With current single sign-on capabilities, a provider merely has to click a button to go from their EHR directly to that patient’s HIE in a quick and efficient fashion.
There is a compelling reason for a provider to join these data networks given the value far outweighs the process of adoption and getting to know the HIE’s capabilities. Although working with an HIE requires providers to adopt a new process, the learning curve to master an HIE is much easier than mastering an EHR.
When to Leverage an EHR vs. an HIE
The terms EHR and HIE are often mistakenly used interchangeably. There is a distinct difference between the two systems, and they each play a vital role in delivering care.
The EHR is an electronic patient chart updated by healthcare providers within a specific practice or healthcare organization. This is the tool most providers leverage daily when providing patient care to capture all the consultation information and include every patient under the provider’s care. The EHR is an essential tool technically serving as the record of care delivered.
An HIE allows for the secure transmission, aggregation, and utilization of patient data between disparate practices and organizations. Clinicians leverage HIEs on a more selective basis, such as when treating complex patients, seeing new patients, or caring for an existing patient that has been treated elsewhere at another practice or organization. Both tools are part of the entire health ecosystem and key to improving patient care and population health. HIEs offers flexibility and is uniquely optimized to best aggregate data from disparate sources, including non-traditional data in a focused, truly patient-centric manner.
Examples of Commonly Used Proven Use Cases for HIEs
There are many areas where an HIE can provide value to a provider, such as:
Direct patient care
When treating a new patient not previously seen at a clinic, hospital, or long-term care facility, often the patient arrives with incomplete clinical information, making the ability to quickly view their aggregated clinical information in the HIE extremely valuable. The HIE also allows providers to track the care their patients are receiving from other providers outside of their EHR capabilities, ensuring continuity of care is optimized. Access to information via an HIE-enabled patient portal can empower patients to get more involved in their care. Another example is generating and monitoring a worklist of seriously ill patients regularly seen by multiple providers (such as cancer patients and transplant patients) and tracking their visits and care via the HIE. Also viewing diagnostic tests and procedures in the HIE reduces redundancy and can lower patient costs and discomfort.
Within a day in the life, HIEs enhance providers’ ability to deliver proactive care rather than just reactive care. Examples include cancer and disease screening, disease surveillance, and determining and triggering appropriate follow-up reminders. As providers experience continued evolution toward value-based care models, the HIE helps them to understand how care is being delivered and provide valuable information around population health.
Transition of care and care coordination
HIEs improve care transitions by providing access to real-time patient information that will follow the patient through the continuum of care. Access to this information can help prevent excess hospital admissions and readmissions. The HIE also acts as a community system by facilitating care coordination from multiple providers and specialists, and ensuring that care is not delivered in silos.
The HIE also supports chronic disease management, especially when working with disparate teams. It is useful for patients who may be seeing multiple providers, as multiple consultations are captured and aggregated in the HIE.
Health analytics often leverage the EHR, but the data is limited to that application. HIEs contain data from multiple EHRs and repositories, allowing for a broader data set to be leveraged. HIEs can also help connect providers who use smaller siloed local instance EHRs, allowing local clinics and rural providers to better serve hard-to-reach or special populations. By using analytics, the HIE can also assist providers address healthcare inequity by identifying which populations to target.
The COVID-19 pandemic has highlighted some of the key areas where the HIE can help, including public health reporting and capturing of test results and immunization data across populations. Since the onset of the pandemic, many providers had to quickly adapt to telehealth and other remote methods of care delivery, and access to more complete information was easily accomplished via the EHR. Many jurisdictions are currently using HIEs as their source of truth to see if a patient has been tested or immunized for COVID-19.
Overall, better clinical information equals better patient and population care, and an HIE facilitates better information. There is no doubt that there is value in both EHRs and HIEs. Although different in nature, they each play a vital role in delivering care and are of great value for different purposes.
There should be no hesitancy to join an HIE. In addition to the benefits, many established HIEs have been around for well over a decade and will be equipped with procedures and processes to support providers in getting the most value out of their HIE.
As the healthcare system continues to evolve, we can expect that HIEs will bring value and efficiency to providers on a daily basis and ultimately help deliver better patient care.
Chris Hobson is the chief medical officer at Orion Health.
Allen Ausford is a clinical professor in the Department of Family Medicine at the University of Alberta.Leave a comment