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Considerations for participating in an HIE


EHRs enable exchange of patient records through health information exchanges, but making the record-sharing work isn’t seamless.

As the healthcare industry moves further into value-based reimbursement models, the need to share patient records becomes increasingly critical to providing quality care in the most efficient manner.

            Health information exchanges (HIEs) are one way to ensure access to all needed patient information. However, selecting and participating in an HIE is not a seamless process, and it requires running through a checklist of questions to ensure success.

To start, physicians should ask whether the practice needs more support sharing records and whether it needs to do that on a regional or national level, said Mari Greenberger, MPPA, director of informatics for the nonprofit Healthcare Information and Management Systems Society (HIMSS).

Not all physicians need more help sharing records.

“If you’re a small rural provider and work with the only hospital there, and you have only one lab, you’re probably getting all the information in that self-contained community. Then you have to ask what value do you get for your patient by being part of a regional or statewide exchange,” said James Turner, MJ, MBA, senior policy counsel for Health IT Now, a coalition of patient groups, provider organizations, employers and payers supporting health IT to improve patient outcomes.

If a practice opts to participate in an HIE, physicians need the right technology, Turner said. An EHR is essential, and it’s preferable to have one certified to meet ONC standards because it’s more likely to have the needed technology.

            Many EHRs today have an application program interface (API) that enables the connection to an exchange, Turner explained, and vendors, the HIE or both often can set up the technical components required for electronic exchange.

            However, physicians may still have to determine whether the practice’s existing EHR has the tools built into the system to support the exchange, whether they’ll have to add on those functions or buy an API or other middleware to enable the data exchange, Turner said.

In addition, physicians may need to set up the EHR to allow patients to opt in or opt out of having their records as part of the HIE, experts said. Physicians also need the EHR to be configured to meet any governing rules that the HIE may have in place.

Next: Weighing the value of an HIE


Weighing the value of an HIE

Physicians should ask, too, whether and how much will the data exchange impact workflow and what kind of queries to the HIE the EHR supports, Greenberger said.

            Moreover, explore what the HIE offers above just record-sharing.

            “The value add of some HIEs is they have middleware and tools that they provide free to doctors, so it becomes a technical resource center as well,” Turner said, adding that some HIEs provide additional services such as analytics engines-an important electronic tool for analyzing data-to entice more physicians to participate.

Other value-adds provided by some HIEs include public health registries and direct messaging service for providers, Greenberger said.

Note, too, that enabling connections between physician EHRs and HIEs is often not the biggest hurdle.

Michael Hodgkins, MD, MPH, chief medical information officer with the American Medical Association, said physicians frequently find that HIEs share patient records in formats their own EHRs can’t easily take in. Additionally, the coding from one system to another varies, so notation for something as simple as patient gender might not transfer from one system into another. As a result, many physicians end up printing out shared records, rather than importing them into their EHRs.

Hodgkins advises physicians to weigh all the multiple factors – whether they need a better exchange or if they’re already getting what they need, the cost of the HIE, how well does it work with their technology, and then decide whether it’s the right move.



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