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.
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:
Texas Public HIEs Public HIEs funded by the ONC are listed. Private HIEs are not included.
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.
TMA Comment Letter to ONC regarding the EHR Reporting Program Request for Information (Oct. 17, 2018)
TMA Comments to ONC Regarding Draft Trusted Exchange Framework (Feb. 20, 2018)
TMA Letter to House Chair, Kevin Brady regarding Health Information Exchange (Feb. 15, 2017)
TMA Comment Letter to ONC Regarding the 2015 Federal Health IT Strategic Plan (Feb. 6, 2015)
TMA Comments to Texas Health Services Authority about the 2014 State HIE Plan (May 30, 2014)
TMA Letter to ONC RE: RFI -- Advancing Interoperability and Health Information Exchange (Apr. 22, 2013)
How Can You Exchange Patient Data? (Texas Medicine Today)
HIEs and the Gateway to Better Care (Texas Medicine)
Patients, Portals, and PHRs (E-Tips)
HIEs Ready to Sign Physician Practices (Action)
TMA Offers EHR Interoperability Tips (Action)
Got HIE questions? Contact the HIT Helpline.