Primer in Health Information Exchange for the Emergency Physician

Abstract

Health Information Exchanges (HIEs), multi-stakeholder organizations that enable the secure exchange and use of electronic health information, offer tremendous potential to improve health care quality, reduce medical errors, and lower costs by paving the way for increased interoperability and information-sharing among patients, providers, payors and other stakeholders. In fact, the state-based and regional HIEs already in operation are providing important user benefits such as more timely communication and secure patient data exchange, regional collaboration, and the elimination of inefficient and duplicate processes. In addition, HIEs are expected to play an important role as building blocks for a proposed National Health Information Network (NHIN) that promotes interconnectivity among users of various forms of health information technologies.HIEs are taking root across the country, despite technical, governance, institutional and funding challenges. Currently, there are more than 150 HIE projects in varying stages of maturity and employing several types of business models. Unfortunately, many of these HIEs may not exist long enough to realize their full potential because their business model is not financially sustainable. The key to sustainability is working with stakeholders to define and develop a business model that addresses the near term needs of individual stakeholders, yet is flexible enough to accommodate the diversity and evolution of these needs.There are many varieties of HIEs available today that are exchanging important health data ranging from comprehensive clinical information to e-prescribing transactions to lab data. Communities should select the type of HIE and business model(s) that best fulfills their stakeholders' needs and offers the greatest chance of early sustainability.The Deloitte Center for Health Solutions (the "Center"), a part of Deloitte & Touche USA LLP, has developed the following point-of-view document that explores the organizational and operational challenges facing today's HIEs as they seek to identify and implement a sustainable business model. The paper also shares characteristics of a successful HIE model and provides suggested strategies for long-term success.The spread of sustainable HIEs and other interoperable health information systems will enable the health care industry to take a major step forward in improving the quality, safety and efficiency of care. First, however, HIE stakeholders must embrace fiscal responsibility and viability to make sure that the promise of HIEs remains in lockstep with the economics.

When Should ED Physicians Use an HIE? Predicting Presence of Patient Data in an HIE

“…We envision the use of HIE to identify MSUs and assign them to community-based case managers who will intervene by visiting these patients and repairing failures in their access to care. 1 …”

“…1–3 Some of these systems support regional “pull” operations using master patient index and record locator service technologies to find and retrieve relevant data from other healthcare systems. Others use an automated admit, discharge, transfer message.…”

“…4,10 ED clinicians offer many reasons for not accessing an HIE, including workflow disruption, time constraints, the need to access multiple password-protected systems, and design flaws in the software. 1,2 One problematic issue is the logon for which the clinician does not find relevant data, a result that leads clinicians to avoid future use. We used data from our HIE to identify patients who visited multiple EDs within a region and created a predictive model based on their demographic and clinical characteristics.…”

Health Information Exchange in the ED: What Do ED Clinicians Think?

“…Survey items 5, 12, 13, 15 through 17, 20, 21, and 23 assessed respondent agreement with CeHA functionality as described in prior publications. 1,7,9,12,13 For example, a stated system need was that available information from participating healthcare systems should be present in CeHA. The corresponding survey item was “Information about my patient was present most of the time when I queried CeHA.” Other functionality attributes included whether CeHA was perceived as easy to use, whether the user was able to quickly find what he or she was looking for, and whether available CeHA data improved the quality of care provided.…”

“…1 Federal initiatives have incentivized the use of health information exchange (HIE) 2,3 to allow routine, real-time sharing of electronic medical record (EMR) information from disparate healthcare systems. The immediate availability of patient data from multiple institutions at the point of care would seem to be of significant value for clinicians; however, HIE adoption and use remain low despite documentation of the potential value.…”