Electronic Health Records

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Three Recent Major Health Information Exchange Developments

By Vera Gruessner

Three recent health information exchange (HIE) developments signal major steps for the secure and timely exchange of clinical data.

HIE provides doctors, nurses, pharmacists, patients, and other healthcare providers with the ability to connect to and share medical information electronically in real time. Both state and federal governments have essentially pushed forward the development of HIEs in order to enhance the quality, safety, and costs associated with patient care.

Some of the top transformations taking place in HIE development include patient matching, greater emphasis on data security and population health management, and achieving Stage 2 Meaningful Use exchange requirements.

In June of last year, the Office of the National Coordinator for Health Information Technology (ONC) published its ten-year goals for creating a more useful national health IT system, according to the American Heath Information Management Association (AHIMA). Patient matching is an important part of ONC’s goals over the next several years.

A more robust patient data matching strategy across the country will bring about greater interoperability among HIE systems. Incorporating a standardized patient data set will ensure that patient records are linked to each other in the HIE and physicians are able to access a full medical history before determining the most appropriate treatment for patients. Adopting a uniform patient matching data set is likely to reduce medical errors and improve the quality of health information.

At this point in time, healthcare organizations are able to match patient records in their own inner system but are finding it difficult to implement patient matching across the board from different care settings to more complex EHR technology.

One option AHIMA encourages to solve the dilemma is to create unique patient identifiers. A patient’s entire medical record could be stored under multiple identifiers across numerous organizations, which may significantly improve patient identification initiatives.

One case study report submitted by NORC at the University of Chicago to ONC illustrates that, out of six states studied (Iowa, Vermont, Utah, New Hampshire, Mississippi, and Wyoming), greater priority was given to population health management and data security.

State HIE programs established privacy and security policies as well as the technical structure and collaboration necessary for the technology to flourish. Greater emphasis has also been put toward developing secure messaging systems.

In order to improve population health management, data repositories proved useful for analytics of aggregated data. For instance, Vermont Information Technology Leaders (VITL) created a centralized data repository in its HIE system. The repository included information from lab orders, care summaries, e-prescribing, lab results, and demographic files.

Utah is also incorporating a data repository, which includes lab results, symptom lists, allergy information, and medication history. In the future, the Utah Health Information Network (UHIN) plans to expand its HIE system in order to maintain a data model among more sizeable health systems.

Stage 2 Meaningful Use requirements also played a vital role in advancing HIE growth. Federal legislation and meaningful use financial incentives pushed forward participation as well. The case study shows that the states focused on payment reform priorities including care coordination.

Essentially, Stage 2 Meaningful Use criteria increase the use of HIE systems. For example, the requirements call for electronic prescribing, care summary exchange among medical providers, electronic exchange of laboratory results, and other population health initiatives.

Clearly, HIE development is on the minds of top officials in the federal government. The Journal of AHIMA reports that the US government will be investing $28 million in order to fund state HIE programs and improve interoperability.

“Through this funding opportunity, grantees will continue to leverage the investments and lessons learned from the earlier Health Information Exchange Programs to advance the standardized, secure, and interoperable movement of health information across organizations, vendors, and geographic boundaries,” National Coordinator Karen DeSalvo, MD, MPH, MSc, wrote in a blog post. “Grantees will address interoperability workflow challenges, technical issues, and improve the meaningful use of clinical data from external sources.”

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