1. DEFINITIONS: What is HIE?

Electronic health information exchange (HIE) allows doctors, nurses, pharmacists, other health care providers, and patients to appropriately access and securely share a patient’s vital medical information electronically—improving the speed, quality, safety, and cost of patient care. The vision of HII is comprehensive electronic patient information when and where needed, allowing providers to have complete and current information upon which to base clinical decisions. Also, clinical decision support would be integrated with information delivery.

2. DRIVERS: Who wants it, and why?

Clinicians: HIE would avoid the need for clinicians to have superhuman memory capabilities to assure the effective practice of medicine, and enable patients more easily to adhere to complex treatment protocols and to be better informed.

Patients: Patients could review and add information to their record and thereby become more active participants in their care. In addition, the availability of comprehensive records for each patient would enable value-added services, such as immediate electronic notiﬁcations to patients’ family members about emergency care, as well as authorized queries in support of medical research, public health, and public policy decisions.

3. USES: Who might use it, and for what purposes?

Insurance industry: When health payers and providers utilize health information exchange, they will make significant gains in reducing healthcare spending, reducing duplicative testing and services, and improving their use of preventive medical services. One of the most important things related to that is preventative care because, ultimately, this is about trying to keep people healthy. That’s how we’re going to manage risk by making that pool of healthy people bigger and reducing overall costs of care through that.

Pharmaceutical Companies: Pharmacists with HIE access can make a significant impact on patient care during hospital-to-home transitions. And the benefits of HIEs don’t end there. HIE would help pharmacists during medication therapy management sessions to educate patients on why they are taking a particular medication and to confirm through lab results whether a drug is working, among other uses.

Government: HIE could support the government access to public health and population health data in a more timely manner than retrospective claims analysis so that they can improve the understanding of clinical needs for District residents and patients.

4. BENEFITS: What are the potential benefits and to whom do they accrue?

A few examples of HIE benefits include1:

Improve patient safety by reducing medication and medical errors;
Increase efficiency by eliminating unnecessary paperwork and handling;
Provide caregivers with clinical decision support tools for more effective care and treatment;
Eliminate redundant or unnecessary testing;
Improve public health reporting and monitoring;
Engage healthcare consumers regarding their own personal health information;
Improve healthcare quality and outcomes; and
Reduce health related costs.
Reference: Healthcare Information and Management Systems Society (HIMSS). “Evaluating a Potential HIE Opportunity [PDF - 100 KB]Web Site Disclaimers”, HIMSS Guide to Participating in HIE. 2009 November.

5. BARRIERS: What forces or factors stand in the way of better HIE?

Six challenges inhibiting electronic data exchange in healthcare, as described by the ONC:

1. Technical barriers. "These limit interoperability through — for example — a lack of standards development, data quality, and patient and healthcare provider data matching."

2. Financial barriers. "These relate to the costs of developing, implementing and optimizing health IT to meet frequently changing requirements of healthcare programs," including lack of incentives for sharing information and need for business models for secondary uses of data.

3. Trust barriers. "Legal and business incentives to keep data from moving present challenges. Health information networks and their participants often treat individuals' electronic health information as an asset that can be restricted to obtain or maintain competitive advantage."

4. Administrative requirements. "Federal documentation and administrative requirements (including billing requirements) contribute to health IT burden due to outdated guidelines for evaluation and management codes that unnecessarily link payment to documentation."

5. Reporting requirements. "Federal reporting requirements in some cases add burden to healthcare providers by requiring them to report on quality measures that are not relevant or meaningful."

6. IT usability. "Health IT system design and usability barriers identified by stakeholders include ... variations in the design [of user-interfaces] that make day-to-day use complicated when a healthcare provider uses multiple systems and the lack of developer engagement with end users of health IT regarding design needs."

Reference: The Office of the National Coordinator for Health Information Technology. 2018 Report to Congress

6. Evaluation of HIE Systems

Thanks to Agency for Healthcare Research and Quality, they provided a complete guide for evaluating Health Information Exchange Projects, through which we could find some key factors and pitfalls when implementing HIE system. The whole evaluation includes six sections, from how to select team to developing evaluation plan, with examples showing evaluation measures.

Section 1. Selecting Your Evaluation Team

When selecting members for the evaluation team, it usually depends on the situations like organization’s size, volume of data being exchanged, the stage in which the organization is currently at, time, and complexity. In general, the evaluation team should cover the following specialities: Technical implementation, Health care operations, Clinical care, Research methodology, Project management, Health care consumer (patient) perspective. Technical implementation covers how IT department implement the HIE system, under the guidance of Project management and Health care operations. In the meanwhile, Clinical care people provide valuable information on clinical details, and Health care consumer specialist would take patient’s need into account during the evaluation.

Section 2. Characterizing Your HIE Project

Key work from this step includes: Describing the HIE project, Identifying the stakeholders, and Articulating the HIE project goals and objectives. Describing HIE project should come directly from the original HIE strategic plan, project plan, proposal, or other documents outlining the vision, mission, goals, and objectives of the project. Key stakeholders that generally appear in HIE projects are all organizations accessing the HIE, funding sources, patients, and any other groups interested in the project. Some questions to help define stakeholders are:

• Who is connecting to the HIE system? Who is interested? Who is impacted? Who is paying for it?

• What do stakeholders hope to accomplish and gain by using the HIE project services?

Section 3. Assessing the Value of HIE

HIE project is being developed and implemented with its goals, providing services to address stakeholders’ concerns or needs. To demonstrate its value to the health care system, an HIE project needs to demonstrate its impact on factors such as patient safety, quality of care, and cost. A first topic to think about is to identify HIE project’s relationship between its usage and value. Two primary approaches are (1) demonstrating financial value through cost savings or increased revenue, and (2) demonstrating improved clinical processes or outcomes. Both financial impact and clinical impact are evaluated to get a full picture of the value of an HIE project.

Section 4. Developing Your Evaluation Plan

Ten steps for developing an evaluation plan:

1. Defining evaluation goals and objectives

2. Identifying potential evaluation measures

3. Designing the evaluation study

4. Identifying data sources

5. Identifying candidate evaluation measures

6. Considering the impact of data collection strategy on relative cost and feasibility

7. Developing your evaluation plan based on selected measures

8. Completing your evaluation plan

9. Reviewing your evaluation budget

10. Finalizing your evaluation plan

Section 5. Creating Your Dissemination Plan

Sharing evaluating results and findings is a great way to inform other organizations which are under similar situation with the HIE projects. Some key questions to think about when disseminating the results: goal, evaluation findings and products, audience and end users, communication, medium, and execution. It is a good idea to keep these in mind: stakeholders, goals, and needs.

Section 6. Examples of Evaluation Measures

The measurements should in general include: measures of the infrastructure development effort, measures of process, measures for data exchange between providers and laboratories, between providers and pharmacies, between providers, between providers and radiology centers, between providers and public health departments, measures for clinical outcomes, clinical process measures, provider adoption and attitudes measures, patient knowledge and attitudes measures, workflow impact measures, and financial impact measures. For detailed examples, please check AHQR website.

Reflection

Reflection blog for Part 7: HIE : click me!

References

Guide to Evaluating Health Information Exchange Projects. AHQR: https://digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/guide-evaluating-health-information-exchange-projects