Health Information Exchange Definition | Challenges | Models | Benefits
Definition of HIE ( Health Information Exchange)
Up to now, health care has been based upon paper records, face-to-face interaction with one provider at a time, that often resulted in segmented, uncoordinated health care.
The exchange of information has been uncoordinated, cumbersome and highly inefficient with silos of valuable information never making their way to those who needed it most.
The physician and patient working together to make decisions.
Now highly efficient care at lower cost with improved health outcomes, a large focus has been placed on the development and exchange of electronic records.
Health Information Exchange (HIE) is the electronic transmission of healthcare-related data among medical facilities, health information organizations.
Companies that oversee and govern the exchange of this data and government agencies according to national standards.
Benefits of Health Information Exchange
- Improve patient care through real-time connectivity.
- Improve patient and physician satisfaction.
- Cost reduction via improved operational efficiency.
- Ability to quantify and measure outcomes.
- Lays the foundation for the medical home, accountable care organizations, and success in Pay-for-Value.
Challenges for HIE
A report published by the Bipartisan Policy Center found that 25 percent of clinicians cited privacy and liability concerns as barriers to participating in health information exchanges.
The argument behind these security concerns is logically sound; if HIE affiliates have increased ease of access to patient information, who else might have this increased access as well?
How can we be sure that sensitive patient and practice information is secure? After all, HIPAA violations are quite expensive.
While this concern is justified, most HIE affiliates recognize this potential shortcoming and have established a wide array of policies to prevent any information leaks.
For example, when electronic requests for patient information from a healthcare provider are made from an unknown provider, most HIEs refuse to provide any data.
As these platforms for data exchange continue to advance and increase in adoption, more policies and safeguards will be put in place to ensure the security of patient files.
Inconsistent or Insufficient Information
Many healthcare providers who have already integrated HIEs into their practice complain that insufficient patient information and inconsistent filing methods are a huge hindrance to HIE success.
Data fragmentation is already an issue for the healthcare system as a whole, costing up to $226 billion per year.
Unfortunately, this is a challenge will take time and continual effort to alleviate. As more hospitals and practices begin sharing data, and as the government groups continue to establish detailed, reasonable standards for patient records, data silos will be broken down.
For many providers, developing HIE networks makes very little sense strictly as a business investment.
According to a study from the Robert Wood Johnson Foundation, 74 percent of respondents listed developing a sustainable business model as a moderate or substantial barrier to HIE deployment, in addition to a high level of concern about a lack of funding (66 percent).
To tackle this issue, some practices are joining cloud-based HIEs, which charge monthly fees, alleviating the heavy upfront costs typically incurred by other systems.
These pay-as-you-go systems can become more expensive than their counterparts however when used for a long period of time. Additionally, transferring patient information through the cloud presents a potential security concern.
But, for cash-strapped practices seeking a means to effectively exchange data, a cloud-based community could be the answer.
Lack of Infrastructure
Similar to lacking proper funding, many healthcare providers list a lack of infrastructure as a major challenge with HIE.
A survey from Doctors Helping Doctors Transform Health Care found that 71 percent of respondents listed lack of infrastructure as a primary challenge.
Adding infrastructure is not only expensive because the infrastructure itself is pricey, but also because the labor and resources required to outfit new systems are expensive as well.
Again, selecting a cloud-based solution can alleviate many infrastructure shortcomings. Cloud systems require very little on-premise infrastructure to gain access and accordingly require minimal labor investment to set up.
While building the proper infrastructure to maintain a normal HIE is recommended, cloud-based options are growing in popularity and accessibility, making it a viable solution for smaller practices and struggling health care providers.
HIEs are far from perfect, but the information and resources they provide can add value to practices everywhere. Unfortunately, many of the improvements that need to happen to HIEs simply require time and commitment from a large volume of healthcare providers.
The technology is there, and eventually, the commitment and investment from practices will be as well.
Common Models that are currently being used throughout the country.
Decentralized Model –
Also known as Federated or Distributed. In this model, all data stays at the point of service (POS) and the participant is a member of an organization and agrees to share their information with the other members of the organization. The key to its infrastructure is a Record Locator Service (RLS). RLS is unique to health information exchange as it is subject to privacy and security requirements and is based on open standards being set by the ONC. The RLS holds the locators of where authorized health information resides, it, however, does not hold the actual health information data. In this model there are variations as the independent databases can be consistent or inconsistent.
Hybrid Model –
When there is a mixture of these models and none are the prominent architecture, it is considered Hybrid.
Centralized Model –
Also known as a Consolidated model. In this model, all data is stored in a single warehouse or data repository and participants regularly submit patient data while being able to view the data through external delivery methods.
This works well in community networks and it is easy to query data. Consolidation of data in a single system can also aid in community-wide data analysis for research and local public health issues. There are currently commercial products available that can be used to facilitate this model. There can also be issues with this model because it relies on the participants to submit data and there is a likelihood of data duplication from multiple providers. Initial financial resources are usually needed as well as good on-going management and maintenance of the central repository.