Health information exchange Connect

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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, 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 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 Recovery and Reinvestment Act of 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 and incentive programs such as "Meaningful Use", which is formally known as the EHR Incentive Program, 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) 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.

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Storage and gathering of information

Data architecture models

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.

Patient consent

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.

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.