- Health information exchange (HIE) will be critical for improving interoperability, especially as technology continues to evolve and the options for transferring and receiving information increase. Along with having the necessary tools for HIE use, healthcare organizations must ensure that employees at all levels are properly trained so potential challenges with data exchange can be overcome.
HIE use is increasing across the nation, with more providers realizing the benefits it can provide in patient care. For example, the Statewide Health Information Network (SHIN-NY) saw its HIE use of admission, discharge, and transfer (ADT) notifications grow by 95 percent among users from 2016 to 2017.
Researchers determined that ADT notification utilization increased by 95 percent between 2016 and 2017, with query-based health data exchange rising by 102 percent, according to findings from the New York eHealth Collaborative (NYeC).
When healthcare organizations understand the benefits of proper HIE use, it can help them work toward a more seamless and secure process.
Improving patient care through HIE use
Expanded HIE use can provide numerous benefits to both patients and providers, helping healthcare work toward its goal of interoperability in the transition to value-based care.
ONC released its Trusted Exchange Framework and Common Agreement (TEFCA) draft in early 2018, designed to streamline patient health data access and exchange per provisions of the 21st Century Cures Act.
Having a single onramp to interoperability is a key TEFCA goal, along with improving patient data access, encouraging population-level data exchange, and having open and accessible application programming interfaces (APIs).
“The draft Trusted Exchange Framework we issued today reflects the successes and challenges already existing in the exchange of health information and is designed to help guide the nation on its path to interoperability for all,” National Coordinator for Health IT Don Rucker, M.D., said in a statement with TEFCA’s draft release.
“The principles and direction we released today, combined with the support of providers, existing health information networks, health IT developers, and federal agencies, are designed to help improve patient care, care coordination, and the overall health of the nation,” he continued.
Improving rural health outreach, developing effective responses to public health crises, and overcoming patient matching problems are just a few specific ways HIE use can help with patient care.
Alabama One Health Record joined the Strategic Health Information Exchange Collaborative (SHIEC) earlier this year in an effort to strengthen patient care delivery and health data access options for patients living in rural and underserved areas.
Alabama Medicaid Agency Director of Health Information Technology Gary Parker explained that joining SHIEC would help Alabama One Health Record expand EHR utilization, care access, and telehealth capabilities.
Individuals who are displaced by natural disasters such as hurricanes and tornadoes will also benefit from the change, ensuring that HIE services can be properly utilized.
“By working together, our HIE members are uncovering ways to better serve vulnerable populations and provide valuable support in emergency preparedness and response to natural disasters, for example,” SHIEC CEO Kelly Hoover Thompson said in a statement. “We all get stronger through collaboration, and together, our members are playing an important role in addressing and overcoming health disparities across the country.”
Optimized HIE use can play a critical role during public health crises, including cases of natural disasters displacing individuals.
For example, such situations often create a sudden and pressing need to quickly access patient EHRs for efficient care delivery, Petaluma Health Center CMIO Danielle Oryn previously explained to EHRIntelligence.com.
Oryn worked with others at the Sonoma County-based Federally Qualified Health Center (FQHC) during the northern California wildfires that took place in 2017.
Health center officials used the eClinicalWorks EHR to issue notifications that the facility was open, while providers utilized the health center’s connection to Surescripts for prescription histories access. Additionally, providers accessed medication lists for patients who didn’t normally receive treatment at Petaluma.
“We’re part of a health information exchange with the other community health centers in our region,” Oryn said. “We have that set up through eClinicalWorks. Many of the health centers around this region use eClinicalWorks. So we are able to see some continuity of care information which includes medication lists, problem lists, and allergies.”
Common challenges, concerns with HIE use
Ensuring health data privacy and security throughout the entire data exchange process is often a key pain point for providers. Organizations need to adhere to all federal and state regulations with data security, while still allowing for data to flow freely as needed for patient care.
The HIPAA Privacy Rule permits a covered entity to participate in PHI disclosure or to use the information or its own treatment, payment, and healthcare operations activities. Covered entities that collected or created the PHI are also allowed to disclose it to another covered entity for treatment or payment.
Additionally, the covered entity could use or disclose PHI for the health care operations of another covered entity that receives the information – to continue caring for the patient in question.
However, the growing number of cybersecurity attacks that compromise sensitive information – including patient PHI and PII – has fueled concern over health data security.
A 2017 Black Book survey found that 87 percent of adult consumers were unwilling to divulge all their medical information in Q4 2016. Digital health information being shared beyond a consumer’s physician and hospital was a top cited worry.
Over half – 57 percent – added that they were skeptical of potential benefits to certain technologies being utilized by a hospital, physician, or ancillary provider.
Eighty-nine percent of those surveyed stated that they in fact withheld information from their provider in 2016. Of those individuals, 93 percent admitted it was because of concerns over personal financial information security.
Physicians are becoming increasingly overwhelmed with the amount of data becoming available through data sharing though, which can lead to provider burden and in effect, less effective patient care.
Reduced data sharing barriers in current HIPAA regulations could help reduce that burden, according to the American Hospital Association (AHA). Restricting patient data sharing for “health care operations” can impact quality assessment and improvement activities, such as outcomes evaluation, AHA explained in a 2017 letter to the House Ways and Means Health Subcommittee.
“The challenge that strict regulatory prohibition poses in the integrated care setting is that patients frequently do not have a relationship with all of the providers among whom information should be coordinated,” AHA wrote. “A clinically integrated setting and each of its participating providers must focus on and be accountable for all patients.”
The CMS’ Patients Over Paperwork initiative also hopes to help reduce administrative burden and physician burnout. Having a collaborative process for evaluating and streamlining regulations to minimize regulatory burden, increase efficiency, and improve the beneficiary experience will benefit providers and patients, according to CMS.
“As we talk about regulatory issues in burden one issue we've heard about over and over again around many communities is the issues around medical records and interoperability,” CMS Administrator Seema Verma explained at the 2017 ONC Annual Meeting. “Many of our providers talk about the system that they are working with and say it was not built for them in terms of how they are delivering care to their patients. It is more suited to a billing system.”
Having all healthcare stakeholders involved will be key to reducing administrative burden, improving interoperability, and strengthening health data exchange options. This will also be necessary in creating a healthcare system that focuses on value-based care and ensuring that patients are put first.
Additionally, focusing on healthcare data security needs can reassure patients that their data will remain protected, even in the health data exchange process. Organizations should also remain current on the latest federal regulatory changes that could impact how information can be used and disclosed.