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Impact of eHealth Exchange on Nationwide Interoperability

The eHealth Exchange functions at a national level to connect existing health information networks and healthcare organizations to improve the secure and information flow of patient data.

By Kate Monica

- Leveraging existing health IT infrastructure is an integral element of the federal plan for achieving nationwide interoperability and successfully implementing a learning health system. The eHealth Exchange is a prime example of this idea in action.

eHealth Exchange improves interoperability through connecting networks of HIEs

Recent developments demonstrate the capabilities of the nationwide network to forge important connections between healthcare providers and health IT systems.

In Washington, the eHealth Exchange is proving useful for military personnel deployed around the globe who need their patient records to follow them to frequently changing locations and providers.

“Time and again, it's been proven that when patient data is readily accessible by the clinician, at the point of care, then the clinician will be able to make better, more well-informed decisions for the patient,” said MIN-NS CEO Mark Quenneville. “As many of our service men and women are deployed around the globe these days. MIN-NS provides a bridge that enable the patient's care record to virtually follow any member of the armed forces, and contractors, from their home base to any deployed location around the globe."

In a similar vein, the nationwide network is improving disability determinations for veterans, allowing Social Security disability case processing sites access to veteran patient records with the Virtual Lifetime Electronic Record (VLER).

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"Currently, when eligible Veterans apply for Social Security Disability Insurance benefits the average wait time for Social Security to receive paper records from VA can take months; this partnership allows Social Security and VA to share the Veteran's health information electronically in minutes,” said VA Under Secretary for Health David Shulkin, MD. “The Social Security and VA partnership allows VA to continue to be a leader in interoperability efforts among federal partners while improving overall quality of life for our Veteran patients."

Outside of the military sphere, eHealth Exchange is contributing to efforts to increase privacy capabilities for those seeking to protect especially sensitive EHR data regarding behavioral health and other unique health data exchange cases. These recent activities are just a few examples of the eHealth Exchange’s progress in the area of nationwide interoperability since its inception in 2006.

Within its first five years, the network grew to 23 participating organizations. In 2012, things picked up significantly after the founding of The Sequoia Project, a non-profit aiming to improve interoperability nationwide, which grew the company to become the largest HIE in the country.

"In addition to seeing a spike in the number of participants, we’ve heard feedback from eHealth Exchange participants saying that the larger the network grows, the more value they’ve been able to get out of it," said Michael Matthews, CEO of MedVirginia and The Sequoia Project President & Board Chair in 2015. "While it may be interesting to connect individual hospital systems with each other, it truly becomes compelling when we’re able to connect most care providers throughout the country – whether big or small, private sector or government."

ONC turned management of the then-named Nationwide Health Information Network HIE over to The Sequoia Project (formerly Healtheway) as part of the initiative to move eHealth Exchange from a public entity to a primarily non-profit, public-private entity.

At present, the organization connects all 50 states, 26,000 medical groups, 4 federal agencies, and almost 50 percent of hospitals. In order to participate in the network, all organizations must agree to a standard set of specifications and qualifications that ensure a secure and interoperable connection.

According to The Sequoia Project, health information exchanges involved with the eHealth Exchange gain the capabilities to send health information to other participating organizations, request health information, match patients with corresponding data, and subscribe to receive updates on health information.

Stakeholders involved with the eHealth Exchange include care delivery organizations using electronic health records (EHRs), consumer organizations that operate personal health records, health information exchanges (HIEs), and specialized participants (e.g.,  public health, researchers).

The eHealth Exchange may also provide interested participating organizations with health information service providers, who can aide with technological or operational challenges.

Healthcare providers will use eHealth exchanges to connect EHR systems to HIEs and promote information sharing. Healthcare consumers can then use these services to access their personal health records and connect to an HIE.

To surmount legal barriers to interoperability, the eHealth Exchange has developed a coordinating committee that provides governance, oversight, management and support of the trust fabric for network participants.

The group’s responsibilities range from determining whether to admit a new participant and resolving disputes among participant to coordinating with ONC to facilitating interoperability of the performance and service specifications with other health information exchange initiatives. 

In 2014, The Sequoia Project began supporting interoperability initiatives including Carequality to expand the breadth of the organizations they cover. Carequality aims to provide an interoperability framework allowing for streamlined health data exchange among networks.

The network has recently teamed up with the Care Connectivity Consortium to further improve health information exchange across systems, networks, organizations, and geographies.  The Care Connectivity Consortium operates as a patient matching service that will lay the foundation for future growth.

The eHealth Exchange is a working example of the potential for existing health data exchange technologies to be reframed, regrouped, and reimagined into a more interoperable network. 

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