Learning from Health Information Exchange Technical Architecture and Implementation in Seven Beacon Communities

Abstract

As health care providers adopt and make “meaningful use” of health information technology (health IT), communities and delivery systems must set up the infrastructure to facilitate health information exchange (HIE) between providers and numerous other stakeholders who have a role in supporting health and care. By facilitating better communication and coordination between providers, HIE has the potential to improve clinical decision-making and continuity of care, while reducing unnecessary use of services. When implemented as part of a broader strategy for health care delivery system and payment reform, HIE capability also can enable the use of analytic tools needed for population health management, patient engagement in care, and continuous learning and improvement. The diverse experiences of seven communities that participated in the three-year federal Beacon Community Program offer practical insight into factors influencing the technical architecture of exchange infrastructure and its role in supporting improved care, reduced cost, and a healthier population. The case studies also document challenges faced by the communities, such as significant time and resources required to harmonize variations in the interpretation of data standards. Findings indicate that their progress developing community-based HIE strategies, while driven by local needs and objectives, is also influenced by broader legal, policy, and market conditions.

Barriers and facilitators to exchanging health information: a systematic review

“…The centralized models include a central data repository that users can query. In federated models, the users query data sources managed by different organizations[34] but this can be a barrier if providers need to log into multiple systems. [19] However, few publications provided the level of technical detail needed to make this comparison.…”

Patient Portals

“…journal.publications.chestnet.org portals as an advanced health information exchange application, 27 how portals can provide decision support to improve patient engagement, 28 the impact of tablet computer use on patient engagement for inpatient settings, 29 and the role of patient engagement in prevention within the context of primary care. 30 From the present review, it is clear that although PHRs could offer great value to providers and patients, research shows very rare use of PHR systems or patient portals among patients with pulmonary conditions, an important gap for future research.…”

Infrastructure to support learning health systems: are we there yet? Innovative solutions and lessons learned from American Recovery and Reinvestment Act CER investments

“…By comparison with 'traditional' research efforts, the complexity of CER requires a larger, multi-disciplinary team to support the wide range of research competencies needed [22]. A collaborative approach to bridge internal knowledge was a priority of the ARRA investments, allowing the projects to develop and nurture trans-disciplinary expertise [23]. Four sites explicitly credited the rich expertise of internal staff with the development of new infrastructure for research and QI.…”