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Community-Based Information Exchange

December 28, 2010
by Mark R. Anderson
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Community-Based HIEs are a Model of Interoperability Among Clinical Information Systems

EXECUTIVE SUMMARY

Mark r. anderson
Mark R. Anderson

Many health providers have focused on community-based health information exchanges (HIEs) as a useful platform to help them take the next steps in implementing electronic health information. Recent research by a healthcare technology advisory firm is an attempt to characterize various HIE models, with an eye on achieving that goal.

Throughout history, major milestones have marked the evolution of modern medicine. Galileo's development of the microscope. Louis Pasteur's findings that airborne microbes, germs, cause disease. Roentgen's identification of X-rays. Fleming's discovery of the antibiotic attributes of penicillin.

COLLECTING AND STORING CLINICAL INFORMATION IN STANDALONE EHR SILOS CANNOT, IN AND OF ITSELF, SUPPORT DATA SHARING. FORWARD-THINKING HOSPITALS AND HEALTH SYSTEMS ARE GOING A STEP FARTHER AND DEVELOPING A FORMAL HIE INFRASTRUCTURE.

Each of these breakthroughs has had a transformative impact on healthcare, advancing providers’ understanding of the disease process, generating highly effective treatments, and improving the health and wellbeing of the population as a whole.

We stand on the edge of similar revolution today. The advent of health information technology (HIT) and newly enacted government regulations are forcing the industry to evolve. The model that has shaped care delivery and reimbursement in the past is undergoing unprecedented changes. Stakeholders along the entire continuum of care-beginning with the patients themselves, and progressing through physicians, provider organizations, health plans and payers-are altering how they view and manage the care processes.

Healthcare reform and meaningful use requirements under the federal American Reinvestment and Recovery Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act have triggered accelerated interest in “next steps.” Many providers have rushed to implement electronic health record (EHR) systems, believing them to be the key to federal funding and effective data sharing.

They are quickly finding, however, that EHRs don't take them far enough down the path towards genuine health information exchange, which is vital to meaningful use and, therefore, government incentives. Collecting and storing clinical information in standalone EHR silos cannot, in and of itself, support data sharing. Forward-thinking hospitals and health systems are going a step farther and developing a formal HIE infrastructure. This strategy definitely represents progress, but it too has limitations. While some accessibility is clearly better than none, the typical hospital-to-provider HIE model creates a fortress of information, impenetrable outside of the hospital's network.

The approach that makes the most sense-and provides the greatest opportunity for scalability-is the community-based HIE, designed to facilitate interoperability among disparate EHR and other clinical information systems. Community-based HIEs provide the infrastructure and platform to share data not only across, but also beyond, a single enterprise. With comprehensive solutions in place, healthcare will be able to achieve truly patient-centric, multidisciplinary care coordination that will address the challenges facing the industry today: lowering healthcare costs while improving access and quality.

The Five Types Of HIE Functionality

Based on its research and ongoing dialog with community-based HIEs, AC Group categorized specific products and platforms according to five types of functionality. After doing so, it compared 16 HIE vendors to these five categories to assist healthcare organizations in matching system capabilities with their specific needs. For example, a single hospital looking for a federated system that will allow only its physicians to access information would require a Type 1 HIE, while a community of competing hospitals and provider organizations desiring to exchange discrete patient data throughout a region should consider a product categorized as Type 5.

Healthcare communities endeavoring to develop a fully functional HIE meeting HITECH requirements and enabling the effective flow of health information should ensure that their chosen solutions will meet long- and short-term goals. Implementing an interoperable product will create a sustainable system that, ultimately, will lead to improved patient outcomes through a higher quality of care coupled with controlled costs.

Types of HIE Functionality

Type 1