Health information exchange, or HIE, is an important component of health informatics because it helps with the transmission of health data between multiple points of care. HIE efforts work to bring “ information about the patient—regardless of where care or services have been delivered— to the clinician and the care team to enable well-informed, coordinated, patient-centered care” (Health Policy Brief). These systems are intended to allow clinicians to access a patient’s health history regardless of where the patient has previously received care. Additionally, these systems can be beneficial to public health organizations, with them playing “a critical role in many other strategies designed to improve the health of populations, including clinical research, assessing the effectiveness of various treatments, monitoring the safety of medical products, and detecting and responding to health threats” (Health Policy Brief). HIE can provide patient level information that may be beneficial on the population level and can allow public health professionals tools to mitigate disease through surveillance and contact tracing.
Public health is a broad discipline that is tasked with protecting the health of entire populations. This is done through implementing educational programs, recommending policies, administering services and conducting research to prevent the spread and occurrence of health problems. In order to do this, “Public health relies on data reported by healthcare partners to conduct nearly every aspect of its core functions” (Shapiro, Mostashari, Hripcsak, Soulakis, & Kuperman, 2011). Historically, reporting processes have been done manually. However, “information technology offers the opportunity to replace manual reporting processes with automated ones, and innovators are increasingly developing such approaches” (Shapiro et al., 2011). One benefit that public health agencies can receive through the use of health information exchange include the transmission of laboratory reports to public health surveillance programs. For example, health departments could use the information that has been given to them to trigger investigations and contact tracing. The HIE could be a “a gateway to relevant epidemiologic information” and assist with not only surveillance programs but also give users information that they may be interested in (Shapiro et al., 2001).
One example of a public health HIE is the Northwest Public Health Information Exchange, or the NW-PHIE. This health information exchange covers points of care across Washington and Idaho and is used by public health programs to monitor and respond to health emergencies. According to a study that examined the NW-PHIE, it was noted that the organization “has implemented HITSP Biosurveillance standards, developed a specification for sharing summary syndromic surveillance data and demonstrated how the NHIN Gateway and services can be used to support public health surveillance” (Dobbs, Trebatoski, & Revere, 2010). This was done through sending patient-level, transactional data to the public health agencies and creating a process for taking that data to create “a patient encounter record which then gets analyzed to identify incidents of importance to public health” (Dobbs et al., 2010). The data that is sent is meant to be easily imported for the creation of epidemiology curves for public health tracking.
Telehealth allows for health professionals and patients who are separated by a distance to use information and technologies to provide care. This can include the practice of medicine between health providers and patients when they are not in the same location and exchanging information between multiple health professionals (Adeogun, Tiwari, & Alcock, 2011). In one model for telehealth, health information exchange is used in multiple steps of the care process. First, alters can be set up to inform or remind patients to carry out tests or take their medications. Then, patients can send their test results to their health providers when tests have been conducted outside of the provider’s office. Additionally, health professionals can set up alerts for the patient to inform the patient of the arrival of the results or when the results are outside of a set parameter. This can lead to the next stage, where “patients and health professionals have a live dialogue either on the phone or through video conferencing to discuss results and progress of patients” (Adeogun et al., 2011). In order to facilitate the visit, providers would be able to have access to the patient’s health information and check the patient’s compliance to their health regimens. Telehealth allows for better connections to care and helps patients achieve care outside of the traditional setting. In order to make sure this is possible, providers should be able to utilize HIE to make sure both them and patients have access to all of the patients’ information.
One way to illustrate health information exchange is to consider the example of COVID-19 surveillance and reporting. Public health agencies could utilize HIE to gather up to date information from emergency rooms, primary care providers, and testing sites to track population level data and to conduct contact tracing. This is important because patients might be using multiple points of care and tracking this information will allow for better individual care and population level tracking. In one example, a patient may be screened for COVID-19 symptoms through telehealth, obtain testing at a drive through site of Health System A, and have a follow up with a provider in Health System B. For this reason, there has to be a system that allows for patient data to follow the patient so providers at these multiple sites can coordinate care and so public health officials can use this information for contact tracing and disease monitoring. One proposed method of further integrating HIE with COVID-19 surveillance is to “link medical records of COVID-19 patients to their cellular devices and obtain the histories of their movements before diagnosis and of other persons whose cellular devices indicate they came in proximity of these persons” (Lenert & McSwain, 2020). While this method could pose important questions about patient privacy, if implemented properly it could be an important tool that uses the integration of technology and contact tracing methods to improve public health outcomes during the pandemic.
(Lenert & Mcswain, 2020)
Meaningful Use was a policy that was created to promote the meaningful use of certified Electronic Health Record systems. This also included ensuring that EHRs could connect and provide for the electronic transfer of information. During the first stage of Meaningful Use, it was “optional for providers transferring a patient to the care of another provider to furnish that provider with a summary of care record 50 percent of the time, and noted that such information need not be transmitted electronically” (Health Policy Brief). This changed during stage 2, where hospitals and professionals were required to submit a summary of care electronically for “more than 10 percent of transitions of care and referrals” (Health Policy Brief). Additionally, during this stage patients would be able to download and transmit their own information. This is important because the Meaningful Use objectives support the interoperability of EHR technologies, which is essential for HIE. Health information exchange organizations that utilize EHR systems for data input benefited significantly from Meaningful Use because it made sure that these systems were able to output their information to other systems.
Just as HIE has benefited from Meaningful Use objectives, HIE is supported in the Federal Health IT Strategic Plan. One example of this is Objective 1C, which aims to advance the communications infrastructure that supports health delivery. This is also a primary use of HIE, meaning that health information exchanges seek to improve the infrastructure that health data is transmitted on and to ensure the health data can be accessible from many points of care. The next example is Object 2A, which involves enabling individuals, providers, and public health entities to securely transmit and access electronic health information. Again, this objective is directly in line with the goals of many HIE systems because a common goal is that patient data can be accessible from not only providers, but also the patients and public health agencies. Similarly Objective 2B, which is to identify and advance the technical standards to support secure and interoperable health information, helps advance HIE because health information exchanges need consistent standards for health information so different health records can be accessed and incorporated into the HIE.
References
Adeogun, O., Tiwari, A., & Alcock, J. (2011). Models of information exchange for UK telehealth systems. International Journal of Medical Informatics, 80(5), 359-370. doi:10.1016/j.ijmedinf.2011.01.013
Dobbs, D., Trebatoski, M., & Revere, D. (2010). The Northwest Public Health Information Exchange’s Accomplishments in Connecting a Health Information Exchange with Public Health. Online Journal of Public Health Informatics, 2(2). doi:10.5210/ojphi.v2i2.3210
Federal Health IT Strategic Plan
“Health Policy Brief: Interoperability,” Health Affairs, August 11, 2014
Lenert, L., & Mcswain, B. Y. (2020). Balancing health privacy, health information exchange, and research in the context of the COVID-19 pandemic. Journal of the American Medical Informatics Association, 27(6), 963-966. doi:10.1093/jamia/ocaa039
Shapiro, J. S., Mostashari, F., Hripcsak, G., Soulakis, N., & Kuperman, G. (2011). Using Health Information Exchange to Improve Public Health. American Journal of Public Health, 101(4), 616-623. doi:10.2105/ajph.2008.158980