Health Information Exchanges

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• Lecture 7
• Health Information Exchanges
• (Chapter 17)

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Learning Objectives

1. Health Information Exchanges (HIE) and Users
2. Key Factors in HIE
3. HIE Business Models
4. Driving Forces for HIE Development
5. Obstacles to HIE Development

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Health Information Exchange
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Health Information Exchange

• Electronic movement of health-related information
  among organizations,
• A process within a state health information
  organization or a regional health information
  organization
• A bidirectional sharing of patient health-related
  information among providers and other authorized
  healthcare professionals

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National Health Information Network

• NHIN provides a standardized, secure, and
  confidential way to link information systems
  together for authorized users to share reliable
  health-related information

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Users of Health Information Exchanges

• Individual level enhance personal health
  outcomes
• Professional level clinical decision making
• Agency/organization level managing operations
  and quality improvement
• Public health and national level accreditation
  bodies to evaluate population health, health
  policy

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Architecture of Heath Information Exchanges
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Key Issues in Heath Information Exchanges

• Data storage
• Master person index (MPI)
• Record locator service
• Authentication
• Authorization
• Security policies
• Auditing and logging
• Standards
• Scope of services
• Knowledge of workflow
• Portals for access

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Data Storage

• To enable the aggregation of data from many
  sources
• Infrastructure models
• Centralized
• Decentralized / federated
• Hybrid

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Centralized Data Storage
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Decentralized Data Storage
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Hybrid Data Storage
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Master Person Index (MPI)

• To uniquely identify an individual
• To match the persons data from many sources
• Could be a complex identifier with multiple
  identification attributes (name, DOB, address)

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Record Locator Service

• A service to search health information that
  matches the identified individual
• Locator can point to a specific types of
  information / criteria

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Authentication

• To identify authentic users to the systems
• Valid users clinical professionals, public
  health professionals, supporting IT professionals
  
• Will include patients in future

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Authorization

• Authorized user matrix WHO can access WHAT
  information for WHAT purpose
• CRUD Function Matrix in database
  Create-Read-Update-Delete

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Security Policies Procedures

• Agreement among organizations to share patient
  data (retrieve, reuse)
• Track requests for information(Require patient
  consent)
• Opt in vs. Opt out

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Auditing Logging

• Keep track all accesses to network services
• Intentional vs. unintentional
• Connection vs. disconnection

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Criteria-based Standards

• To assure the interoperability and reuse of
  information from many sources
• Data communication protocols
• Data content, format
• Technical compatibility among systems

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Scope of Services Provided
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Knowledge of Workflow

• Data processing procedure (When, Who, How)
• Patient data types (What, Whose)

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Portal for Access

• Different portals for different types of
  information exchanges

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Health Information Exchange Models

• Government-led HIE direct government program
• Public utility HIE with government oversight
• Private sector-led HIE government as a
  stakeholder for collaboration and advisement
• Public authority HIE a government created
  nonprofit authority with powers to operate in a
  business-like manner

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Health Information Exchange Business Models

• Business models designed for financial
  sustainability
• Membership fee model
• Transaction fee model
• Program and service fee model

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Driving Forces

• Reduce data duplication and related costs
• Reduce discrepancies among information from may
  sources and related fixing costs
• Provide a uniform holistic picture of the
  patients health to improve care quality
• Underlying key success factor Electronic Health
  Records (HER) and Electronic Medical Record (EMR)
  must be first broadly adopted/implemented

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Current Obstacles

• Size and scope of the project
• Time / Costs
• Critical mass of data to be exchange
• Collaboration between competitors (providers)
• Technical skills / necessary clinical knowledge
  to use the system
• Resistance to change
• Composition and structure of governing agency

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Future Directions

• Statewide HIE initiatives have started
• HIE enabler/readiness (coordinating initiaties)
• HIE outsourcing/technical partnership (technology
  implementation and services)
• HIE operator (implementation and management)
• A national health information network to be build

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Some References

• http//www.himss.org/files/himssorg/content/files/
  hie/hie_guidewhitepaper.pdf
• http//www.himss.org/files/HIMSSorg/content/files/
  RHIO/RHIO_HIE_GeneralPresentation.pdf
• http//www.health.state.mn.us/divs/hpsc/ohit/hiegu
  idance/hieguide.pdf