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Mobilization of health care information electronically across organizations
Health Information Exchange (HIE) is the electronic exchange of health care information across organizations within a region, community, or hospital system. Participants in this data exchange are collectively called Health Information Networks (HINs). HIE may also refer to the Health Information Organization (HIO) facilitating the exchange. HIE aims to facilitate access to and retrieval of clinical data, particularly to support public health authorities in analyzing the health of the population.
In the United States, the Office of the National Coordinator for Health Information Technology supports statewide health information exchange through financial grants. These grants were legislated into the HITECH components of the American Recovery and Reinvestment Act of 2009.[1] Regional Health Information Organizations (RHIOs) are typically geographically defined entities that develop and manage contractual agreements, facilitate electronic information exchange, and establish and maintain HIE standards.[2] Federal and state regulations regarding HIEs and health information technology (HIT) are still being defined. Federal regulations and incentive programs such as "Meaningful Use", formally known as the EHR Incentive Program,[3][4] are changing. Most HIEs and RHIOs remain tied to federal, state, or independent grant funding to remain operational. Some exceptions exist, such as the Indiana HIE.[5][6]
Storage and gathering of information[edit] Data architecture models[edit]In a centralized model of HIE, there is a central (or master) database that holds a copy of every patient’s records. Information is uploaded to a single database from which any provider in the HIE can access and download. In a federated model of HIE, there is no master database; records are exchanged electronically among providers when needed.[7][8]
Exchanges in the US must operate with patient consent to comply with not only the Health Insurance Portability and Accountability Act (HIPAA) but also a variety of state and federal laws and regulations. This was clarified by the Office of Civil Rights in the January 2013 Final Omnibus Rule Update to HIPAA.[9]
Explicit consent and implicit consent are two methods for gaining patient consent. With explicit consent, or opt-in, a patient is not automatically enrolled into the HIE by default and generally must submit a written request to join the exchange. In implicit patient consent, or opt-out, patients give implicit consent to join an HIE when they agree to use the services of a healthcare provider who participates in an HIE and sign the provider's Notice Of Privacy Practices. Patients can request to opt out of the HIE, generally with a written form.[10]
Notable European health information exchanges[edit]Connecting the Medical Centre Leeuwarden and the Academic Center in Groningen with community hospitals such as Nij Smellinghe Hospital in Drachten,[11][12] the Friesland Regional Cardiology Network reduces patient hospital stays by one or two days.[12] Once records are uploaded to the cardiology network, they remain available for consultation at any time, allowing healthcare providers to review a patient's previous episodes of care.
North of the Netherlands – XDS Network[edit]Hospitals in the Dutch provinces Groningen, Friesland, and Drenthe have created a (diagnostic) image exchange network to phase out CD/DVD-based exchanges using an HIE (XDS) platform. St. Gerrit, the local HIE organization, has gradually expanded the network since 2014, spanning 10 hospitals to date.
CRISP serves as the state-designated HIE for Maryland and the District of Columbia. It is a nonprofit organization that connects healthcare providers and patients to enhance care coordination and patient outcomes. CRISP integrates health information from hospitals, laboratories, pharmacies, and other healthcare entities, enabling providers to access real-time patient data. It focuses on ensuring that providers have access to the information they need to make informed clinical decisions.[18]
Key Features:
Health Info Net operates as the state-designated HIE in Maine, offering a centralized repository of health data for its users. It connects hospitals, clinics, and other healthcare providers, creating a comprehensive view of patients' medical histories. By reducing redundant testing and improving clinical decision-making, Health Info Net aims to enhance the quality and efficiency of healthcare delivery.[20]
Key Features:
Arizona's Health Information Exchange, led by the state's Medicaid agency, provides a web-based platform to facilitate the exchange of health information among providers. This system helps bridge the gap between healthcare organizations and ensures that patient medical records are accessible regardless of the provider they visit. The Arizona HIE has been instrumental in improving care coordination and reducing costs associated with fragmented care.[21]
Key Features:
The Indiana Health Information Exchange is a nonprofit organization recognized as one of the largest and most comprehensive HIEs in the United States. IHIE connects hospitals, physician practices, laboratories, and other healthcare entities across Indiana, facilitating a seamless flow of information. Its services are designed to provide healthcare providers with complete and timely data to support better decision-making and patient care.[22]
Key Features:
Manifest MedEx is a nonprofit HIE based in California, focusing on real-time health information exchange to improve care coordination and patient outcomes. It collaborates with hospitals, health plans, and healthcare providers to deliver a comprehensive view of patient data. Manifest MedEx emphasizes the importance of actionable insights to drive better healthcare outcomes.[23]
Key Features:
The Colorado Regional Health Information Organization serves as the state-designated HIE for Colorado. CORHIO connects healthcare providers, including hospitals, clinics, long-term care facilities, and laboratories, to ensure seamless access to patient data. Its mission is to improve the quality, safety, and cost-effectiveness of healthcare delivery through technology and collaboration.[24]
Key Features:
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