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Meaningful Health Care Informatics Blog

May 7 2012   11:13AM GMT

Top considerations when planning on joining an HIE



Posted by: RedaChouffani
CareConnect, Health information exchange, HIE

More independent physicians are being solicited to connect to a community, local, or state HIE.  Since many of these entities have gone live in higher numbers this past year, and continue to see an increase especially due to the meaningful use stage 2 proposed ruling, physicians will continue to find themselves with several vendors and options from which to choose. Below are a few important areas of considerations for all providers taking the next steps forward in data exchange:

Connectivity with other existing community based (private HIEs) and state or national (NHIN):

One of the core components and purposes of an HIE is to provide continuous availability to medical records, enabling physicians to make better treatment decisions and deliver a higher quality of care in a more efficient manner.  When joining an HIE, providers must also consider what other entities the HIE can use to locate charts electronically.

Contracts:

When joining an HIE, a physician would be subscribing to the services that will be offered.  They will also be agreeing to local state laws around HIEs as well as specific liability and data security requirements set forth by the HIE. These contracts must be reviewed in great details, as they are very complex. The binding legal document will address privacy, security concerns, technical issues, as well as any obligations that maybe associated with early termination.

Usability of system and patient information:

There are several different methods of accessing a patient’s chart through an HIE.  One of the most commonly used and simplest method is via the HIE’s web portal which allows the physician to connect securely and perform record searches for patients.  This set up does not require any special software or interfacing to gain access to the record information.  Another access method that provides a seamless and common interface is through the use of physician’s EHR to request and process incoming patient’s summary chart.  This allows for some of the outside patient information to be combined with current physician’s patient records.  It is important to consider the connectivity model that can help create efficiencies for the organization, so both must be evaluated to ensure the right option is selected.

Value added services:

A great example of how some of the HIE are providing subscribers value added services is what a NC based HIE is doing.  CareConnect Carolinas a local HIE through Carolinas Health System is providing the following services:
·         Comprehensive medication list from SureScipts as well as many other local and national pharmacy networks.
·         Access to patient’s imaging records available through the hospital Information System
·         Access to Lab reports, Transcriptions, letter, Encounter details, Patient facesheet
·         Advanced alerting capabilities such as flags for drug seekers
·         Downloadable CCD (Continuity Care Document)
·         An EHR Lite to assist physicians with Meaningful Use
·         Referral management to digitize the information exchanged during the referral process
·         Web orders for certain labs at some of the health system facilities

There are other health systems that are also providing a PHR access feature for the patients.  This feature provides another method for the patient to be engaged and actively maintain their health record.  It also encourages up to date information even it is manually entered.

Pricing model:

Similar to many of the online subscription based services, HIEs fees are monthly.  Whether it is the physician or health system, they pay a reoccurring monthly fee for the length of the agreement. There is some setup fee associated with most and possibly additional third party charges when interfacing or integrating with an EHR.

Integration capabilities with existing system:

Not all HIEs provide integration with all EHR systems.  Ideally an HIE can provide a strong and tight integration with an EHR product and allow end users to simply use their electronic medical records application which they are already familiar with.  This will enable physicians to simply use the same application to manage patient charts as well as request medical records from an HIE.  But unfortunately, not all HIEs or EHRs allow for this integration.  So for some access to an HIE web portal that provides the ability to print/save the summary record is as far as the system will go.

With the proposed meaningful use stage 2, and 3 there is a stronger emphasis on the electronic exchange of medical records through a qualified Health Information Exchange.  And more physicians and organizations will begin to review some of the available HIEs in their community and state.

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