Health Information Exchange of HIE is the most commonly heard abbreviation in healthcare. There are a lot of invaluable information about the same that is available in the internet, journals, textbooks and other sources. This blog is a humble attempt by Harish Sakala and S.Karthik at exploring some of the common terminologies and process in HIE
1.
Introduction
Health Information Exchange or
HIE as the name itself indicates refers to the exchange of health information.
The health information can be information related to a patient’s current
condition, or prescription or any diagnostics tests. The HIE can happen between
any of the following,
o
Provider to Practitioner
o
Provider to Diagnostic Laboratories
o
Provider to Radiology Service providers
- Provider to Patient
- Provider to Immunization Registries
The following are some of the
areas where HIE is used,
- Referral Management
- Order laboratory tests and receive results
- E-prescription
Following are the some of the HIE
networks including:
- Physicians
- Hospitals
- Regional Health Information Organizations
- State Government Agencies|
- Others as Healthcare evolves (i.e., ACOs., etc)
HIE will help providers in
emergency treatment, improved care, informed decision making and minimization
of errors involved in manual methods of information exchange. The below is a
high level depiction of the various methodologies that are used in HIE
Source: HIMSS Florida
HIE Lessons Learnt
This the Low level flow
methodologies that are used in HIE
As the above picture indicates,
the following are the different methods of exchanging health information that
are in vogue,
- Fax and Paper
- Point to Point
- Enterprise wide HIE
- HL7
o
TCP / IP
o
XML and web services
- NHIN Direct
- NHIN Connect
- VPN
- Proprietary Solutions
While most of the HIE are pull in nature there are a number
of instances like the following which are push in nature,
- E-prescription to a pharmacy
- Laboratory test results from a laboratory to a
EMR / PM system
- ADT (Admission Discharge Transfer) event
2.
Architectural Approaches in HIE
The following are the different
architectural approaches involved in implementing a HIE,
- Federated Architecture
- Centralized Architecture
- Hybrid Architecture
Federated Architecture: A federated HIE is a collection of local repositories
that are remotely located. The patient’s data is located at the provider level.
The requesting application queries the patient’s data. The HIE’s patient
registry will locate the information, authenticate the requestor and verify if
it is authorized to receive that information. The patient registry or Record
Locator Services (RLS) uses a combination of unique patient identifiers such
name, social security number, to locate a patient record. On successful
verification, the source system will respond with a “Yes” response if the
record is available.
If the user chooses to view the
record the same is displayed in a in a predetermined format like PDF. It is to
be noted here that the recipient has got a read only access and cannot save the
record that he is viewing. It is not saved in the cache also.
If a user is querying a lab
result the system will search for that particular order or result and display
the same. If the user is querying for patient medical history or demographics
information, the system will search all possible locations in that network
where the information is available and display links to it.
Centralized Architecture: In a centralized architecture the
patient’s medical records are stored in a centralized location. The record is
constantly updated through interfaces from connecting applications usually on a
daily basis. In this model the HIE is responsible for ensuring information
security and authenticating the systems that share data. Though the data in a
centralized location is a summation of data from multiple systems there is a
logical separation between data from different systems.
Source: Stratis Health HIE Technology Document
The Master Patient Index (MPI) is
the algorithm that is used to match patients that are being queried.
Hybrid Model: The Hybrid model is a via media between Federated
(decentralized) Centralized model. This model ensures that the complete patient
information is available in real time where publishers post data and consumers
have access it. In this model a Record Locator Service (RLS), MPI and
Healthcare provider directory are used. The system aggregates different medical
information for the same patient into a single record which can be queried and
directly imported into the destination system.
HIE ‘s can also be classified on
the basis of number of entities that are involved in HIE as
- Type 1
- Type 2
- Type 3
- Type 4
- Type 5
i.
Type One
HIE : Type 1 HIE is designed for a single hospital or a hospital exchange
that wants to seamlessly provide hospital specific data to its providers in one
common view. Traditionally, the data is viewed within the HIE. Data is not
transferable into a provider’s specific EHR product as discrete data.
ii.
Type Two
HIE: Type 2 HIE facilitates data sharing between different practices
utilizing the same EHR product. Through a specific vendor’s data exchange
protocols, specific patient data can be exchanged between multiple provider
organizations. A Type Two HIE can also receive data from hospitals and
laboratory facilities. Traditionally, a Type Two HIE does not exchange data
with other EHR vendor products. An HIE at this Type can provide PHR capability,
but only among practices using the same EHR product. A Type Two HIE is usually
governed by one hospital organization, or by a smaller local provider
community.
iii.
Type
Three HIE: Type 3 HIE provides data sharing between different practices who
are utilizing a short list of different EHR products. The Type Three HIE is
traditionally distributed by an EHR vendor claiming it can connect other EHR
vendors with its product. The Type Three HIE exchanges data using one specific
vendor’s data exchange protocols. An HIE at this Type is generally built from
the ground–up, and utilizes multiple point-to-point interfaces.
Type Three HIE
can receive data from hospitals and laboratory facilities and provide PHR
capability, but once again, only with other organizations using the same EHR
product.
iv.
Type Four
HIE: Type 4 HIE has the ability to exchange discrete patient data
(following CCD methodology) between multiple practices with selected EHR
products, hospitals, radiology centers and laboratory facilities, even if they
are on separate Healthcare products.
iv.The Type Four HIE provides a community MPI
and a community patient portal for patient communications with each care provider.
The data is able to be transmitted seamlessly into each provider’s EHR as
discrete data.
The Type Four
HIE also provides e-prescribing capabilities for those providers that have not
embraced EHR technology. An HIE at this Type is often governed by a community
of competing hospitals and provider organizations throughout a region.
v.
Type Five
HIEs: Type 5 HIE have the
ability to exchange discrete patient data (following HITSP C32 version 2.5 or
higher CCD record format) between multiple practices with different EHR
products and with hospitals, radiology centers and laboratory facilities, even
if they are on separate vendor systems.
Type Five HIE
provides a community MPI and a community patient portal for patient
communications with each care provider. The data is able to be transmitted
seamlessly into each provider’s EHR as discrete data.
The HIE should
possess a community Patient Health Record (PHR) capability, designed to provide
each patient with a centralized location for demographics and clinical history.
The Type Five
HIE also provides e-prescribing applications, for those providers that have not
embraced EHR technologies, and offers extensive disease management and outcomes
measurement data capture and reporting.
Type Five HIEs
are governed by a community of competing hospitals and provider organizations
throughout a region. The goal of a Type Five HIE is to improve the quality of
healthcare in the community while reducing costs via patient data coordination.
3.
Reference
