Health Information Exchange

  • How Do You Exchange Patient Data?

    One of the greatest benefits of health information technology (HIT) and electronic health records (EHR) is the ability to securely access and share patient information at the point of care.

    Ideally, all members of a health care team -- physicians, specialists, hospitals, labs – should be able to use HIT and EHRs to share patient information through a secure network, a process called interoperability. In fact, the Centers for Medicare and Medicaid Services (CMS) recently renamed the Medicaid Meaningful Use and MACRA’s Advancing Care Information (ACI) programs to Promoting Interoperability. Although there has been some progress toward interoperability, a lot of work remains.

    Use the resources below to find out how to get started.

  • Accomplishing HIE

    There are different ways HIE can be accomplished, and the needs and requirements vary by practice.

    While there are numerous ways to accomplish HIE, below are four types of HIE that are currently in use:

    • Direct is a technical standard for securely exchanging health information between health care entities such as physicians, specialists, hospitals and labs in a trusted network. Direct functions like regular e-mail but with HIPAA security measures in place that ensure the person receiving the message is the intended recipient. Direct addresses are available from a variety of sources, including EHR vendors, public and private HIEs, as well as private service providers offering Direct exchange capabilities called Health Information Service Providers (HISPs).
    • Public health information exchanges (HIEs) are available around the state of Texas covering different regions. The public HIEs can provide information about patients at the point of care. Some of the information includes lab results, medications, hospitalizations, and radiology reports. Each HIE is developing various services according to the needs in its specific region. Reach out to the HIE in your region to find out what services are offered and to learn details about participation, including cost.
    • Private HIEs are typically operated by a hospital or health system which controls funding, governance and participation opportunities. The private HIEs offer similar patient information to public HIEs, but the data will likely be limited. If you are affiliated with a health system, inquire about HIE opportunities.
    • Health IT vendor interoperability can occur through organizations such as Commonwell Health Alliance and Carequality. These organizations are focused on providing the cross-vendor interoperability infrastructure that is patient-centered. Physicians that are interested in this option can ask their EHR vendor about their status of participation or membership in either of those organizations.
  • Texas HIEs

    Texas Flag Sketch  

    Texas Public HIEs 
    Public HIEs funded by the ONC are listed. Private HIEs are not included. 

  • Questions to ask HIEs

    Before committing to a local health information exchange (HIE), physicians need to ask questions. Physician health information technology experts recommend physicians consider the following:

    • What information will be shared via the HIE?
      Some HIEs will share only laboratory data, while others will allow access to discharge summaries, notes, test results, and more.

      How will physicians be able to determine the source, date, and time of the data?
      Answers to these questions will help physicians reconcile contradictory information they may encounter, such as a “penicillin allergy” for a patient pulled from one electronic medical record but “no known allergies” pulled from another.

      What privacy and security mechanisms does the HIE feature?
      Physicians should learn the HIE’s policies and procedures on how they’ll obtain patient consent for using the data. If a patient chooses to exclude some data from being shared, the physician should make sure the HIE discloses that fact.

      Does the HIE include the patient populations, referral networks, and the hospitals and other physicians the doctor works with?
      Make certain the HIEs connect to the local hospitals, labs, radiology services, and other facilities. Taking part in an HIE with limited connections could leave doctors having to make decisions based on partial information.

      Will the HIE be financially viable in the future?
      It’s not simple to move from one HIE to another. Physicians should ensure the HIE has a thorough business plan with strategies for long-term success and staying power. If the HIE has been in existence for a while, physicians should ask their colleagues about the exchange’s track record and functionality.

      Is there a fee to participate?
      Many HIEs will be free initially, but physicians should ask whether potential future fees have been addressed.

      Who is on the HIE board of directors?
      HIE governance should represent health care stakeholders in the community.

      What are the computer system requirements to connect to the HIE?

      Does the HIE use a centralized or decentralized model?
      Physicians participating in exchanges that use a centralized model obtain a patient’s permission to have their records and information stored in a database. Physicians and other health care professionals can query the database for patient information and share it with others. In a decentralized model, the physician stores patient information and permits access by authorized personnel and entities.

      Are there opportunities to provide feedback on HIE operations?
      Physicians should inquire about their ability to attend HIE meetings and to weigh in on the system’s functionality.

  • HIE Advocacy Efforts

    “Patient Privacy Must Be Protected,” TMA Says in Response to Ascension-Google Partnership (Texas Medicine Today, Nov. 14, 2019)

    TMA Comment Letter to ONC Re: Trusted Exchange Framework and Common Agreement (TEFCA) Draft 2 (June 17, 2019)

    TMA Comment Letter to ONC Re: the EHR Reporting Program Request for Information (Oct. 17, 2018)

    TMA Comment Letter to ONC Re: Trusted Exchange Framework and Common Agreement (TEFCA) Draft 1 (Feb. 20, 2018)

    TMA Letter to House Chair, Kevin Brady Re: Health Information Exchange (Feb. 15, 2017)      

    TMA Comment Letter to ONC Re: 2015 Federal Health IT Strategic Plan (Feb. 6, 2015)

    TMA Comment Letter to Texas Health Services Authority Re: 2014 State HIE Plan (May 30, 2014)

    TMA Comment Letter to ONC Re: RFI -- Advancing Interoperability and Health Information Exchange (Apr. 22, 2013)

  • TMA is helping to strengthen your practice by offering advice and creating a climate of medical success across the state.

  • What could a TMA membership mean for you, your practice, and your patients?