Health information exchange (HIE) plays a critical role in the drive towards interoperability in healthcare. HIE evolved as a solution to data silos that emerged among hospital and health systems and the variety of electronic health record software they implemented, providing necessary technology and infrastructure for secure, digital exchange of clinical data to help improve the health of the communities that they serve.
While the value of HIEs to public health has been growing—especially in light of COVID data needs—there are organizations, including programs within state and local public health departments, that may not have had the opportunity to connect with an HIE to learn HIE benefits firsthand. In light of this, Innovations in Newborn Screening Interoperability (INBSI) hosted a webinar in December that gave an introduction to HIEs and how they can help public health programs specifically for organizations in charge of newborn screening programs.
Audacious Inquiry’s Director of Clinical Applications, Dr. Marc Rabner, shared his knowledge as the Clinical Advisor to CRISP, the HIE supporting Maryland, Washington D.C., West Virginia, Connecticut, and Alaska. He was joined by Dr. Brandan Kennedy who is the Director of Medical Informatics and a Pediatric Hospitalist at Children’s Mercy in Kansas City and is also on the Board of Directors at the Lewis and Clarke Information Exchange (LACIE-HIE). Together, they provided an overview of ways HIEs can facilitate public health use cases and offered tips for getting started with an HIE.
What is Health Information Exchange (HIE)?
An HIE is essentially a digital information hub that allows electronic health records (EHRs) used by healthcare providers and other entities involved in the health space to send and receive clinical data through a secure network. Dr. Rabner opened the webinar by giving a brief history of health information exchange. Back in 2004, clinics and health systems nationwide were transitioning from paper filing to EHRs to meet the 2014 target for health record digitization set by the recently established Office of the National Coordinator for Health Information Technology (ONC). While EHR and HIE technologies have been replacing paper patient records and faxing for file exchange, the new challenges that have emerged include breaking down data silos and creating opportunities to engage public health with these robust data sources that respect patient privacy and autonomy.
This is where the HIE really comes into play by sending and receiving patient health information from many different EHRs, so that a primary care practice, emergency department, pharmacy, health insurance company, or public health program can quickly access and share critical health data in real time. The HIE operates as an information hub that can send and receive clinical data from a range of EHRs used by different hospitals, clinics, and other healthcare providers and payers. The more EHRs connected to an HIE, the more information they can access, creating greater value for all participants.
By breaking down barriers between siloed EHR software and allowing for seamless information exchange, HIEs can facilitate effective coordination of treatment plans and communication between healthcare providers and public health programs concerned with accurate reporting. HIEs can also allow for the collection of big data feeds that can offer insights into population-wide health trends for greater public health awareness and more effective health monitoring and resource allocation. Dr. Rabner and Dr. Kennedy also discussed common functionality among HIEs that makes this possible.
Common Functions and Benefits of HIEs
While there are HIEs at the local, state, and national level that have different systems for operation, there are common functions that allow them to play such a critical role in the health IT space. Dr. Kennedy began by explaining that when patients move from one hospital or one care site to another during their healthcare journey, their health information does not necessarily move with them. In these scenarios, an HIE can help share vital pieces of clinical data with all members of their care team to avoid duplication of labs, imaging, and procedures. An HIE enables the flow of this information from one institution to another, with the information becoming readily available right in a patient’s record. By having accurate and timely health information, care is safer and more efficient, which can improve health outcomes and reduce costs. According to the ONC, the timely information provided by HIEs can lower the risk of duplicate testing, avoid medication errors, improve diagnoses, and prevent readmissions.
Other basic functions of HIEs include patient matching between data sources, which is important for public health programs that may want to share critical information with other members of a patient’s care team—but need to ensure the person in that program is the same person being cared for in the hospital or clinic. With a high degree of accuracy, the health information exchange uses patient demographic information to match patient records from different organizations into one combined record for that patient. As an example, Dr. Rabner explained that if an admitting hospital misspelled his first name during intake, the HIE can still match his clinical data from the hospital to his health record from his primary care provider’s EHR, even though there was an error in the name.
HIEs also store information about the relationships between patients and the members of their care team. One component of gaining secure access to patient records through the HIE requires each organization to send panels of their patients to the HIE. Those panels can be used to understand who the patient’s care team is, including their primary care doctor, their payer, and can even include things like which public health programs they access. Utilizing this information, the HIE can clearly show who makes up that patient’s care team—enabling improved communication and coordination among the team.
Health Information Exchange Examples: Newborn Screening Program
To put the role of HIEs and their functions into context for newborn screening programs, Dr. Rabner shared two specific use cases that have been successful at CRISP. The first use case helped to address the issues associated with the manual entry of patient information into the Maryland Department of Health’s Early Hearing Detection and Intervention (EHDI) programs data system. CRISP worked with every birthing hospital to compile their admission, discharge, transfer (ADT) data for newborns. Using the ADT data and the newborn demographic data they carry, CRISP was able to create one feed that flowed directly into the EHDI system that allowed for the demographic data to be automatically populated. This made it possible for the hearing technician or audiologist performing the newborn hearing screening to access the EHDI system and find the patient’s data pre-populated and accurate rather than having to input the information manually. This leaves less room for human error during manual data entry and better matching of information across data systems.
Another use case being developed will help newborn care providers that need to access multiple systems to retrieve patient newborn screening lab data from the Maryland Department of Health State Lab. In partnership with the Maryland Department of Health, Dr. Rabner and the CRISP team are working to send newborn screening labs directly into CRISP. With patient matching, the newborn screening labs display alongside the patient’s other labs and clinical data that providers can already easily access. CRISP is already used by many pediatric providers and has a robust infrastructure to onboard new members of the care team quickly while ensuring robust data privacy. This improves the access to this information for the relevant members of the care team who need it most.
HIE and Public Health Policy Considerations
Most HIEs originated from the need break down silos between hospital and health systems and their EHRs. HIEs are able to provide this clinical information exchange in part because of stakeholders’ trust in data stewardship and privacy made possible by the development of data governance structures. The ONC defines HIE data governance as, “The establishment and oversight of a common set of behaviors, policies, and standards that enable trusted electronic health information exchange among a set of participants.” These governance structures developed for HIEs ensure appropriate data use—many of which include specific policies and processes for public health entities. Public health programs that are interested in working with HIEs should discuss these data governance needs and requirements to ensure HIEs maintain the highest degree of data stewardship and privacy.
Advice for Public Health Programs Interested in Connecting to an HIE
For public health entities interested in working with an HIE that are not sure how to get started, Dr. Rabner and Dr. Kennedy offered advice. The first step is to identify a use case with a manageable scope that can grow incrementally. Small projects with quick wins can grow into bigger projects, but it’s easier to get started with a smaller project than with complicated large ones. Come up with a few of those small use cases that are valuable to important stakeholders, then build that value incrementally, use case by use case.
Then, Dr. Rabner suggests thinking about the “why” and the “what” required of the project with the HIE by asking these questions:
- Does my organization have health data that other members of the care team would find valuable or vice versa?
- Why do I want to share the data?
- What is the data going to be used for?
From there, programs can work with the HIE to figure out how to create a technology solution and any policy or governance challenges that must be considered to enable that data sharing.
Once the public health organization has established some use cases and reasons for connecting to an HIE, the next steps are for the organization to contact the HIE it wants to connect with and ensuring it has stakeholder support to get started.
For guidance on how to work with an HIE or to work on a customized roadmap for outreach onboarding, contact Audacious Inquiry to connect with one of our advisors who specialize in HIE adoption strategies.
