Defining Health Information Exchange Terms
Resource for understanding HIE and HIO terms is the June, 2008 report Defining Key Health Information Technology Terms [PDF - 376 KB] located at http://healthit.hhs.gov/portal/server.pt?open=512&objID=1239&parentname=CommunityPage&parentid=22&mode=2&in_hi_userid=11113&cached=true
What is an HIE?
A Health Information Exchange (HIE) assists with the transfer and sharing of health related information that is typically stored in multiple organizations, while maintaining the context and integrity of the information being exchanged. An HIE provides access and retrieval of patient information to authorized users in order to provide safe, efficient, effective, and timely patient care. Formal organizations have been created in a number of states and regions that provide technology, governance, and support for HIE efforts. Those formal organizations are termed Health Information Organizations (HIO) or Regional Health Information Organizations (RHIO).
HIEs are formed by a collective group of stakeholders from a specific area or region to facilitate the electronic exchange of health-related information for the purpose of improving health care for a defined population. Thus, the HIE provides the ability for participating organizations to safely and securely share health information with authorized providers to improve and expedite the clinical decision making process. An HIE is not an information system within a single organization, nor is it one that has a single directional flow of information. A true HIE involves multi-directional flow of information electronically between providers (hospitals, physicians, clinics, labs) and other sources of administrative or clinical information provided by consumers, health plans, employers, local, state or national organizations.
Commonly Offered Services
An HIE is a complex set of technologies which enables the aggregation of health related information for an individual as well as offering a number of specialized services for the community it serves. Usually, HIE capabilities are described as a set of electronic “services” that allow the HIE to interact with participating systems in a consistent, reliable way. The illustration below highlights an architectural view of the different services that one can expect from an HIE.[1] From a clinical or business perspective, access channels contain types of services such as physician web portals, personal health records, clinical messaging, clinical interoperability and exchange of data from electronic medical records as well as the common administration of security services necessary to insure that data is used appropriately.
In order to provide these services, HIEs are architected to use one of two forms of data sharing methods (or both), which are referred to “push” and “pull” technologies. Understanding the difference between how clinical data is obtained in an HIE is important because it will dictate the method in which information is shared. “Portals are a pull (query) technology, requiring physicians to search for the data they need. Push technology, on the other hand, automatically delivers clinical data to the user in the desired format: paper, fax, electronically to a viewer or electronically to an EMR of the physician’s choice. Best in class Push technologies also allow for tailoring of various types of results and data delivery.”[2] In addition, “A good HIE solution should provide a push technology, delivering the vast majority of hospital and other results, while also providing a query solution for the few use cases where there doesn’t yet exist a patient-physician relationship that would enable push delivery.”[3] HIE’s must provide access to information regardless of the technology in use or not in use. There are still a large percentage of physicians who do not have access to electronic medical records in their offices. Understanding this technology is important for determining which methods are most appropriate for obtaining and viewing patient data.
Source: The HIMSS Guide to Participating in a Health Information Exchange assists in the decision-making process of joining a health information exchange (HIE). The first four sections provide the background necessary to understanding HIEs, followed by common approaches and data standards. The appendices include case studies outlining different models, terminology glossary and a checklist of questions that should be considering in the evaluation of a particular HIE opportunity.
[1] Massengill, Stephanie “Can Portals Deliver?” ADVANCE for Healthcare Information Executives, March 2009. p2
[2] Massengill, Stephanie “Can Portals Deliver for Hospitals and Integrated Delivery Networks?” HIMSS News. March 2009.
[3] Fairchild Consulting, Greater Rochester IPA Architecture Briefing, 2008.