8 crucial factors in charting a direction for health info exchange
With electronic health records systems in wide use today, the next step for healthcare organizations is to exchange the data they contain to support coordinated care. That’s often difficult between different vendors’ records systems, so health information exchanges will play an important role in sharing patient information for the foreseeable future. Even though HIEs have been around for several years, providers often are ill-prepared at first to work with them successfully.

The National Rural Health Resource Center has compiled practical health information exchange resources to help providers understand the process and get the most benefit. Here are its key insights for success.
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Assess readiness
While health information exchange is one of the key requirements of Stage 2 of the electronic health records meaningful use program, not all practices have the IT acumen to achieve it. Determining whether a practice is ready to join an HIE can be a challenge. The NRHR toolkit provides basic information to consider when evaluating HIE options.
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Decide on a do-it-yourself initiative
Some providers may decide that their needs are unique enough to require them to build their own HIE—that decision could set off a complex series of decisions, and it should be made early in the process. Most privately built HIEs are owned and operated by hospitals or hospital systems because of the capital requirements and policy development required. The benefits of building an HIE include tailoring use-cases directly to providers’ needs, controlling the storage and usage of all data within the network, and the ability to set privacy and security controls.
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Consider links to statewide HIEs
Many states are building a statewide infrastructure for HIE. These exchanges offer a range of capabilities that often include a record locator service, provider directories, secure messaging and exchange of electronic lab results. Statewide exchanges have been subsidized by the federal government to lower the cost of building the upfront infrastructure. The benefits of joining a statewide HIE include communication with regional affiliates, access to state provider directories and low-cost exchange options.
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Incorporate the Direct Project approach
Industry stakeholders in recent years developed the Direct Project, which is a set of standards and protocols to support secure messaging across trusted organizations. This initiative has evolved into the National Health Information Network. The secure messaging applications are similar to commonly available email applications, but provide encrypted messaging to ensure the safety and security of communication. The Direct Project requires the user to know the recipient’s address, as most Direct Project applications do not include a system for searching and finding patient records or provider contacts. However, benefits outweigh the limitations—the Direct Project supports nationwide communication, secure encryption, attachments, cost-effective information exchange and simple implementation.
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Consider EHR vendor solutions
Many electronic health record vendors offer information exchange modules within the EHR to support exchange of information among providers using the same type of EHR. A limited number of vendors can offer clients data exchange between multiple EHR vendors, and some offer complete interoperability using vendor-to-vendor interfaces. The benefits of an organization using its EHR vendor for data exchange include functionality built into the EHR, minimal disruption to clinical workflows and low use of internal technical resources.
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Weigh participation in private HIEs
Private HIEs are common and offer exchange within a common network. Private HIEs are offered by provider collaboratives, state hospital associations, regional non-profits and software vendors. The benefits of joining a private HIE include a wide variety of capabilities, proven use cases and financial sustainability.
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Consider the organization’s distinctive factors
The National Rural Health Resource Center offers an HIE readiness self-assessment to help an organization consider if it is ready to adopt HIE and identify the operational, financial and technical considerations necessary to build a sustainable private HIE. Benefits include improving care transitions, increasing the number of referring physicians, reducing readmissions and administrative costs, and boosting revenue from enhanced billings and collections.
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Make the final call
Following the HIE self-assessment, an organization may seek to dig deeper and conduct a more detailed readiness assessment. Components to consider include an environmental scan, health exchange use cases, operational goals and benchmarks, HIE workflow assessment, interoperability assessment, meaningful use gap analysis and financial sustainability.
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