Health information exchange


Health information exchange is the mobilization of health care information electronically across organizations within a region, community or hospital system. Participants in data exchange are called in the aggregate Health Information Networks. In practice the term HIE may also refer to the health information organization that facilitates the exchange.
HIE provides the capability to electronically move clinical information among different health care information systems. The goal of HIE is to facilitate access to and retrieval of clinical data to provide safer and more timely, efficient, effective, and equitable patient-centered care, which may also be useful to public health authorities in analyses of the health of the population.
HIE systems facilitate the efforts of physicians and clinicians to meet high standards of patient care through electronic participation in a patient's continuity of care with multiple providers. Secondary health care provider benefits include reduced expenses associated with:
According to an internal study at Sushoo Health Information Exchange, the current method of exchanging patients' health information accounts for approximately $ of expenses annually for a single-clinician practice.
Formal organizations are now emerging to provide both form and function for health information exchange efforts, both on independent and governmental or regional levels. These organizations are, in many cases, enabled and supported financially by statewide health information exchange grants from the Office of the National Coordinator for Health Information Technology. These grants were legislated into the HITECH components of the American Recovery and Reinvestment Act of 2009. The latter organizations are ordinarily geographically defined entities which develop and manage a set of contractual conventions and terms, arrange for the means of electronic exchange of information, and develop and maintain HIE standards.
In the United States, federal and state regulations regarding HIEs and HIT are still being defined. Federal regulations and incentive programs such as "Meaningful Use", which is formally known as the EHR Incentive Program, are rapidly changing the face of this relatively new industry. In addition to changes driven by federal activities, the lessons learned in the ongoing implementation of some state-sponsored HIEs and the fluctuating nature of health care regulations at the level of the state governments themselves are leading to additional refinement. However, HIEs and RHIOs continue to struggle to achieve self-sustainability and the vast majority remain tied to federal, state, or independent grant funding in order to remain operational. Some exceptions exist, such as the Indiana HIE.

Storage and gathering of information

Data architecture models

There are two main models for the data architecture of health information exchanges. One is a federated, or decentralized model, and the second is a centralized one. There is also a hybrid model that contains elements of both. In a centralized HIE there is a central database which holds a complete copy of all of the records of every patient contained in the HIE. In a federated HIE there is no master database.
In a federated model, each health care provider is responsible for maintaining the records of their individual patients. In this model, the main function of the HIE is to facilitate the exchange of patient records among providers as the need arises. For example, if a physician in a federated HIE requests the records of a query is sent to each server in the system asking to return any records that they have pertaining to. Each federated HIE may accomplish this in a slightly different way, but the salient distinction is that in a federated model there is no central database from which a previously compiled comprehensive medical record is stored and can be downloaded.
In short, in a federated HIE, records are exchanged electronically among providers when they need them. In a centralized model, all patient information is uploaded to a single database from which any provider in the HIE can download a patient's full medical record.

Patient consent

Exchanges in the US must operate with patient consent to comply with not only the Health Insurance Portability and Accountability Act, but a variety of state and federal laws and regulations. This was clarified by the Office of Civil Rights in the January 2013 Final Omnibus Rule Update to HIPAA.
There are two methods for gaining patient consent. One is explicit consent and is termed opt-in. With this method, a patient is not automatically enrolled into the HIE by default and generally must submit a written request to join the exchange.
The other method is implicit patient consent and is termed opt-out. In this method patients give implicit consent to join an HIE when they agree to use the services of a health care provider who is submitting data into an HIE and sign the provider's Notice Of Privacy Practices. In this model patients can request to opt out of the HIE, generally with a written form.
Under the provisions of Title 45, §164.522, however, medical providers are not obligated to agree to restrict a patient's records and can freely exchange patients records via the various HIEs.

List of European health information exchanges

The Netherlands

;Frysian Health Information Exchange

North of the Netherlands – XDS Network

Hospitals in the Dutch provinces Groningen, Friesland and Drenthe have created an image exchange network in order to phase out CD/DVD based exchanges using an IHE platform. St. , the local HIE organization has gradually expanded the network since 2014, spanning 10 hospitals to date. Diagnostic images and related reports are to support a number of use-cases including radiology referrals to the Academic Medical Center Groningen, radiotherapy treatments, CVA Stroke and proton therapy. The HIE network has development a number of cross-enterprise workflows using IHE .

Other Dutch HIEs

Overview

StateNameOversight agency
AlabamaAlabama Medicaid HIEAlabama Medicaid Agency
AlabamaOne Health Record AlabamaAlabama Medicaid Agency
AlaskaAlaska eHealth NetworkAlaska Department of Health and Social Services
American SamoaAmerican Samoa Health Information ExchangeAmerican Samoa Department of Health
ArizonaArizona Governor's Office of Health Information Exchange
ArkansasSHAREArkansas Office of Health Information Technology
CaliforniaBrown & Toland Medical GroupCalifornia Office of Health Information Integrity
CaliforniaCAReHINState of California Office of Health Information Integrity
CaliforniaCentral Coast Health ConnectState of California Office of Health Information Integrity
CaliforniaConnect HealthcareState of California Office of Health Information Integrity
CaliforniaDignity HealthState of California Office of Health Information Integrity
CaliforniaE Health CaliforniaState of California Office of Health Information Integrity
CaliforniaHealthcare PartnersState of California Office of Health Information Integrity
CaliforniaHill PhysiciansState of California Office of Health Information Integrity
CaliforniaHoag HIEState of California Office of Health Information Integrity
CaliforniaHuntington HospitalState of California Office of Health Information Integrity
CaliforniaJohn Muir HealthState of California Office of Health Information Integrity
CaliforniaKaiser PermanenteState of California Office of Health Information Integrity
CaliforniaLANES LAState of California Office of Health Information Integrity
CaliforniaManifest MedExState of California Office of Health Information Integrity
CaliforniaMemorial Healthcare SystemState of California Office of Health Information Integrity
CaliforniaNorth Coast Health Information NetworkState of California Office of Health Information Integrity
CaliforniaOne California Partnership Regional Health Information OrganizationState of California Office of Health Information Integrity
CaliforniaPalo Alto Medical FoundationState of California Office of Health Information Integrity
CaliforniaRAIN-Live OakState of California Office of Health Information Integrity
CaliforniaRedwood MednetState of California Office of Health Information Integrity
CaliforniaSac Valley MedshareState of California Office of Health Information Integrity
CaliforniaSt. Joseph Health SystemState of California Office of Health Information Integrity
CaliforniaSan Diego Health ConnectState of California Office of Health Information Integrity
CaliforniaSan Joaquin Community HIEState of California Office of Health Information Integrity
CaliforniaSan Francisco General HospitalState of California Office of Health Information Integrity
CaliforniaSan Mateo Medical CenterState of California Office of Health Information Integrity
CaliforniaSanta Cruz HIEState of California Office of Health Information Integrity
CaliforniaSharp HealthcareState of California Office of Health Information Integrity
CaliforniaSutter HealthState of California Office of Health Information Integrity
CaliforniaTulare Kings Foundation for Medical CareState of California Office of Health Information Integrity
CaliforniaVigilance HealthState of California Office of Health Information Integrity
ColoradoCORHIOColorado Regional Health Information Organization
ColoradoQuality Health NetworkColorado Regional Health Information Organization
ConnecticutWestern Connecticut Health NetworkState of Connecticut Department of Public Health
ConnecticutERICCAState of Connecticut Department of Public Health
DelawareDHINDelaware Health Information Network
District of ColumbiaCRISPDistrict of Columbia Department of Health
FloridaFlorida Health Information ExchangeFlorida Agency for Healthcare Administration
Memorial Healthcare System
FloridaUniversity of Florida Health
Strategic Health Intelligence
Broward Health
Bethesda Health
Tampa Bay HIE
FloridaFlorida Hospital/Adventist
Community Health IT - MyHealthStory
FloridaFlorida Accountable Care Services
Senior Home Care
GeorgiaArcHIEGeorgia Department of Community Health
GeorgiaChatham County Safety Net Planning CouncilGeorgia Department of Community Health
GeorgiaGA TelehealthGeorgia Department of Community Health
GeorgiaGeorgia Health Information NetworkGeorgia Department of Community Health
GeorgiaGracHIEGeorgia Department of Community Health
GeorgiaHealtheConnectionGeorgia Department of Community Health
GeorgiaWest Georgia Health SystemGeorgia Department of Community Health
GuamGuam HIEGuam Department of Health
HawaiiHawaii HIEHawaii Health Information Exchange
IdahoIHDEIdaho Health Data Exchange
IllinoisIllinois Health Information Exchange Illinois Department of Healthcare and Family Services
IndianaHealthBridge Inc.Indiana Health Information Technology
IndianaHealthLINC Inc.Indiana Health Information Technology
IndianaIndiana Health Information Exchange Inc.Indiana Health Information Technology
Indiana & MichiganMichiana Health Information Network, LLCIndiana Health Information Technology & Michigan Department of Health
IowaIowa Health Information Network Iowa Department of Public Health
KansasKansas Department of Health and Environment
KansasLewis & Clark Information Exchange Kansas Department of Health and Environment
KentuckyKentucky Health Information ExchangeCabinet for Health and Family Services
LouisianaLaHIELouisiana Health Care Quality Forum
MaineHealthInfoNetMaine Office of Health and Policy Finance
MarylandCRISPMaryland Department of Health and Mental Hygiene
MassachusettsMass HIwayMA Executive Office of Health and Human Services
MichiganAdministrative Network Technology Solutions Michigan Department of Health
MichiganMichigan Department of Health
MichiganHenry Ford Health System Michigan Department of Health
MichiganIngeniumMichigan Department of Health
MichiganJackson Community Medical Record Michigan Department of Health
Michigan & IndianaMichiana Health Information Network Michigan Department of Health & Indiana Health Information Technology
MichiganNorthern Physicians Organization Michigan Department of Health
MichiganPCE SystemsMichigan Department of Health
MichiganSoutheast health Information Exchange Michigan Department of Health
MichiganUpper Penninusla Health Information Exchange Michigan Department of Health
MinnesotaEmdeonMinnesota Department of Health
MississippiMississippi Health Information NetworkMississippi Department of Health
MissouriLewis & Clark Information Exchange Missouri Department of Social Services
MissouriMissouri Health ConnectionMissouri Department of Social Services
MissouriTiger Institute Health AllianceMissouri Department of Social Services
MontanaHealthShare MontanaMontana Designated Health Information Exchange Organization
NebraskaNebraska Health Information InitiativeNebraska Department of Administrative Services
NevadaHealtHIE NevadaNevada Department of Health and Human Services
New HampshireNHHIONew Hampshire Health Information Organization
New JerseyCamden CoalitionNew Jersey Health Care Facilities Financing Authority
New JerseyHealth-e-cITiNew Jersey Health Care Facilities Financing Authority
New JerseyJersey Health ConnectNew Jersey Health Care Facilities Financing Authority
New JerseyNew Jersey HiTecNew Jersey Health Care Facilities Financing Authority
New MexicoNew Mexico Health Information Connection LCF Research, New Mexico
New YorkBronx RHIONew York eHealth Collaborative
New YorkHealth e ConnectionsNew York eHealth Collaborative
New YorkHealth Information New YorkNew York eHealth Collaborative
New YorkHealthixNew York eHealth Collaborative
New YorkHEALTH e LINKNew York eHealth Collaborative
New YorkHealthlink NYNew York eHealth Collaborative
New YorkRochester NY RHIONew York eHealth Collaborative
New YorkSouthern Tier Health LinkNew York eHealth Collaborative
North CarolinaCoastal Connect Health Information ExchangeNorth Carolina Department of State Treasurer
North CarolinaNorth Carolina HIENorth Carolina Department of State Treasurer
North CarolinaWestern North Carolina Data LinkNorth Carolina Department of State Treasurer
North DakotaNorth Dakota Health Information NetworkState of North Dakota, Dept. of Information Technology
Northern Mariana IslandsCommonwealth of the Mariana Islands
OhioCliniSyncOhio Health Information Partnership
OhioGreater Dayton Area HINGreater Dayton Area Hospital Association
OhioHealthBridgeHealthcare Collaborative of Cincinnati
OklahomaCoordinated Care Oklahoma Oklahoma Health Care Authority
OklahomaMy Health Access NetworkOklahoma Health Care Authority
OregonCare Accord Oregon's State Information ExchangeOregon Health Authority
OregonReliance eHealth Collaborative Oregon Health Authority
PennsylvaniaHealthShare Exchange of Southeastern PAPennsylvania e Health Authority
PennsylvaniaClinicalConnect Health Information ExchangePennsylvania eHealth Authority
PennsylvaniaKeystone Health Information Exchange Pennsylvania eHealth Authority
Puerto RicoPuerto Rico Health Information NetworkLa Fortaleza Office of the Governor of Puerto Rico
Rhode IslandRhode Island Quality Institute Rhode Island Department of Health
South CarolinaSouth Carolina Health Information Exchange South Carolina Department of Health & Human Services
South DakotaSouth Dakota Health LinkSouth Dakota Department of Health
TennesseeEast TN Health Information NetworkState of Tennessee Office of eHealth Initiatives
TexasFirst NetTexas Health and Human Services Commission
TexasGreater Houston HealthconnectTexas Health and Human Services Commission
TexasHealthcare Access San AntonioTexas Health and Human Services Commission
TexasHealth Information of South TexasTexas Health and Human Services Commission
TexasHIE TexasTexas Health and Human Services Commission
TexasPasa Del Norte Health Information ExchangeTexas Health and Human Services Commission
TexasRio Grand HIETexas Health and Human Services Commission
TexasRio One HIETexas Health and Human Services Commission
TexasSETHS Operated Provider HIETexas Health and Human Services Commission
U.S. Virgin IslandsVirgin Islands Department of Health
UtahUtah Health Information Network Utah Department of Health
VermontVermont Information Technology Leaders Inc. Vermont Agency of Human Services
VirginiaConnect VirginiaVirginia Department of Health
WashingtonOneHealthPort HIEWashington Healthcare Authority
WashingtonNorth Shore Medical GroupWashington Healthcare Authority
WashingtonSkyline HospitalWashington Healthcare Authority
West VirginiaWest Virginia Health Information Network West Virginia Department of Health and Human Resources
WisconsinWISHIN PulseWisconsin Department of Health Services
WyomingWyoming e-Health PartnershipState of Wyoming Office of the Governor

Individual exchanges

;Chesapeake Regional Information System for our Patients
;Health Current, formerly Arizona Health-e Connection
;CORHIO - the Colorado Regional Health Information Organization
;Delaware Health Information Network
;Great Lakes Health Connect
;HealthShare Exchange of Southeastern PA
;Idaho Health Data Exchange
;Indiana Health Information Exchange
;Kansas Health Information Network
;Keystone Health Information Exchange
; Michiana Health Information Network
;Missouri Health Connection
; Ohio Health Information Partnership — CliniSync HIE
;Pennsylvania eHealth Partnership Authority
;Utah Health Information Network