Health Information Exchange (HIE): Connectivity, Integration and Interoperability

The formation of a universally connected healthcare network has stirred a technology driven revolution in the United States. The network has been structured so that patients may have greater access to their health information, as well as increased connectivity with physicians, pharmacies, and clinics. To realize it, an influx of EMR, EHR, e-Prescription and other practice management tools by healthcare IT companies are harnessing the complexity of supported infrastructure and its implementation. The revolution is further corroborated with legislations, rules, standards and incentives by the government.

Connecting the interwoven web of lines that link hospitals, physicians, data warehouses, insurance carriers, billing companies etc. is not as simple as this graphical illustration. The actual process is extremely complex due to secure, powerful and efficient health information. There are many factors that come in to play, such as, real-time connectivity, seamless integration of IT systems and interoperability of health information.

Connectivity lays the foundation for health information exchanges (HIEs) which promote themselves primarily to the provider community. The point of an HIE is to offer shared data that would not be there if not for the consent and participation of patients. HIE’s enhance the level of care coordination, i.e., in a specialty practice, a doctor might not have privileges at a patient’s hospital. The HIE provides them the ability to tap into a health exchange portal and access the hospital record which improves consultations and reduces duplication. It is indicative of how information is following the patient and points in the direction of where the future of medicine is heading.

Integration of healthcare IT solutions needs to come equipped with advanced information exchange protocols and coding capabilities. EMR systems are instrumental in digitizing and hosting electronic versions of medical records. Working parallel, EHR systems are more sophisticated in disseminating healthcare information. To create a web of healthcare networks, these applications are to be combined with the power of web and online solutions, such as, e-Prescription and patient portals. The whole idea of integration matures when a variety of software and hardware solutions work in harmony, sharing information across networks. There is a fine line dividing integration of these heterogeneous systems and interoperability and health information.

Interoperability is a leap ahead from just making a network of connected devices. Different technologies communicate with each other, using shared information for a purpose i.e. improving health care in a more efficient way. Currently the obstacles hindering the interoperability of health information are due to evolving changes e.g. (CCR, CCD / XML, HL7 coding and transaction standards) uniformity of which is necessary to align syntactic and semantic interoperability.

Working in the direction, ONC has planned 3 stages to ensure an effective exchange of health information among healthcare service providers. Demonstrating stage 1, eligible professionals must “provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, and medication allergies) within four business days of the information being available to the EP.” Stage 2 focuses on interoperability, and the focus would shift to real use of patients’ health records at the point of care and improving outcomes through collaborative decision making. Similarly, stage 3 would be focused on improving efficiency through examples of healthcare delivery and payment reforms.

Security and privacy of the data exchanged is of extreme concern for healthcare technologists nowadays. Cases of data breaches and theft of health information is raising questions over the success of this system. Without edifying the trust among all the stakeholders, health information exchange cannot bear its fruits for providers, patients, researchers and public healthcare entities.