Essay on Electronic Health Information Exchange Organizations (HIEs)

Introduction

Health Information Exchange (HIE) involves healthcare providers exchanging health information and patient data electronically. Through evidence, there has been a rapid growth of sharing via HIE system among healthcare service providers (Unertl et al., 2012). National and regional HIE initiatives are being developed and advanced in a few countries including the USA, Finland, Netherlands and England. Reduction of mortality and healthcare costs, facilitation of health efforts, quality of care and efficiency, care coordination and patient safety could be potentially improved through sharing of clinical data. Nationwide, there is use of various clinical data exchange models, e.g., Patient-centered models, query-based HIE, non-directed exchange model and direct project model (Ancker et al., 2012).

Clinical information access on-demand is the critical role played by Health Information Exchange (HIE). Information integrity is ensured when disparate healthcare information systems exchange health information electronically through HIE. A structure for consumer health informatics research, biomedical surveillance, clinical quality measurements, and public health reporting is also provided by HIE. The trust shared between the HIE itself, the healthcare provider, and the patient influences the success of any HIE. Guiding policies and procedures such as devising ways to maintain and secure Protected Health Information (PHI) must be developed and implemented by HIE if the trust is to be built (Heath et al., 2017).

Adoption and implementation of HIEs

Among healthcare providers and institutions, the sharing of electronic data has been encouraged in tandem with the goals of the federal program known as “Meaningful Use.” Adoption and use of HIE has been at a minimal despite financial incentives offered by the federal government (Adler-Milstein & Jha, 2014). Mandated adoption programs that support HIE initiatives and healthcare cost reduction motivation alone will not motivate healthcare providers to adopt HIE as evidence suggests. Various phases which constitute HIE assimilation need to be defined by further studies on the subject and to facilitate this process, more supportive regulation are required (Geissbuhler, 2013).

Factors beyond technical issues are the determinants of the success of the adoption and implementation of HIE. Studies should be conducted on influential factors that are relevant to the adoption and implementation of HIEs such as organizational, operational and social contexts. Network levels of analysis and individual user are the main focus of previous studies while the utilization of HIE at the organizational level of analysis is explained in a handful of other studies (Vest, 2010). Without examining organizational factors and considering HIE at organizational level, it is highly unlikely that an HIE project’s success and its potential benefits will be realized. Thus, there should be a critical highlight of organizational factors, e.g., training, technical support, organizational support, resource allocation, barriers to organizational adoption decision, organizational adoption and implementation strategies, organizational awareness and commitment, organizational characteristics, and the organizational value of HIE (Walker et al., 2005).

Adoption and implementation phases are affected by diverse determinants and there is a difference between implementation processes and adoption efforts according to evidence. A series of interrelated phases instead of a single unified process influence the multifaceted process that is HIE assimilation. Despite the interrelated processes of institutionalization, implementation and investment, HIE adoption has been analyzed as a single step by multiple HIE literature. According to Politi et al. (2014), patterns of HIE assimilation have been analyzed by a limited number of studies. The similarity of early research in HIE assimilation characterizing exclusively based on patterns is the other gap in literature that exists (Vest et al., 2012). The HIE system and healthcare practice have a variable and complex nature as shown by Rebbuge and Ferreira (2012). If implemented and integrated into clinician’s workflow, HIE benefits can be achieved according to Frisse and Holmes (2007). Injury or death can occur from diagnosing a wrong care planning or doctor’s delay in identifying health problems that is caused by sharing incomplete information among other deficits in the exchange of health information. Hospitals could still be blocked from participating in HIE by various factors such as hospital characteristics, market conditions, technical issues and current policies (Vest et al., 2013).

Federal policies

The exchange of PHI is governed by many federal laws and regulations. The confidentiality and integrity of PHI are safeguarded by the provisions included in the HITECH Act, HIPAA, and the Privacy Act of 1974. To ensure compliance, every federal law and regulation affecting HIE’s operations must be reviewed. Under HIPAA, the current federal protections for the privacy and security of PHI are expanded by the HITECH Act. The Food, Drug, and Cosmetic Act, the Gramm-Leach-Bliley Act, the Family Educational Rights and Privacy Act, the federal regulations regarding Confidentiality of Alcohol and Drug Abuse Patient Records, and the federal regulations regarding Confidentiality of Alcohol and Drug Abuse Patient Records are other federal laws and regulations that affect health information exchange. Ideally, these laws should not be plagued by conflicts; nonetheless, pre-emption applies when federal laws conflict with state laws. To ensure compliance, legal counsel should be consulted with regard to the HIE (Kruse et al., 2014).

Harmonizing State and Federal regulations

The privacy and security of PHI are governed and managed by stringent laws enacted by many States. To ensure compliance with across States, State laws must be reviewed under HIE, just like in Federal rules and regulations. In the event that two similar State and Federal laws overlap, HIE must take into account State laws, pre-empting Federal laws. Additionally, guidance on these matters requires consultation of legal counsel. Information and data sharing will only be possible if these differences are resolved, particularly during emergencies.

HIE success

Multiple components make up the success of HIE. Health Information Exchange Organizations (HIEs) need to navigate other factors apart from setting expectations, developing contracts, understanding laws and regulations, and putting policies and procedures in place in order to ensure success. Enforcing privacy and security protections, monitoring and managing operations for compliance, establishing responsibility and building trust are paramount to a successful HIE operation (Williams et al., 2017).

HIE maintenance in Minnesota

For instance, in the State of Minnesota, maintenance of HIEs involves ensuring that the staff members are given sufficient support, e.g., in training through monitoring related policies and workflows. Additionally, security issues in the State are monitored carefully, mainly when there is a change in HIE trading partners or when the organization changes staff members. Strong relationships should be maintained between the technical partners, e.g., HIE and EHR vendors and business partners that include HIE trading partners. What an organization needs from its technical and business partners needs to be evaluated as new HIE services are offered through the evolving HIE landscape. Moreover, in order to keep pace with the industry, HIE technology and infrastructure should ensure to keep current on national standards. Statewide adoption of specific standards is recommended and monitored at the State-level by the Minnesota e-Health Initiative.

Education of HIEs

With the help of stakeholders, the primary focus of different governments of various countries is placed on the need to work on critical areas. To achieve any particular health goal, various strategies can be used. The use of health information from other areas is one of the primary strategies. Critical towards advancing the healthcare outcomes for individuals living any given region is the health information exchange system. The international healthcare information system stipulates that such information should be exchanged through an electronic means although some healthcare information exchange systems cause problems in the handling of patient information. Organized and structured healthcare systems are the mainstay of developed countries such as Japan, China, the United Kingdom, Canada and the United States. Nonetheless, the success of HIE in all the afore-mentioned countries is not dependent on the system’s stability or structure, rather it depends education and leadership of the healthcare organizations (Yuehong et al., 2016).

Conclusion

When healthcare providers share electronic patient data with other providers, that is when the benefits of HIE such as patient care coordination, quality improvements and potential cost saving will be visible. Assimilation of HIE goes beyond installation of required components and organizational adoption decisions. Despite healthcare institutions adopting HIE, they may decide not to share information with disparate healthcare providers. When the potential benefits of HIE are gained by the providers from the use of an implemented HIE system, exchange of patient information is ensured. Failure to address the continued existence of barriers by the current policies can explain the low adoption and utilization of HIE.

References

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Frisse, M. E., and Holmes, R. L. (2007). Estimated financial savings associated with health information exchange and ambulatory care referral. Journal of biomedical informatics, 40, S27-S32.

Geissbuhler, A. (2013). Lessons learned implementing a regional health information exchange in Geneva as a pilot for the Swiss national eHealth strategy. International journal of medical informatics, 82, e118-e124.

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Walker, J., Pan, E., Johnston, D., Adler-Milstein, J., Bates, D. W., and Middleton, B. (2005). The Value of Health Care Information Exchange and Interoperability: There is a business case to be made for spending money on a fully standardized nationwide system. Health affairs, 24(Suppl1), W5-10.

Williams, K. S., Shah, G. H., Leider, J. P., and Gupta, A. (2017). Overcoming barriers to experience benefits: a qualitative analysis of electronic health records and health information exchange implementation in local health departments. eGEMs, 5(1).

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