The Office of the National Coordinator for Health Information Technology Health IT Playbook

Section 3

Health Information Exchange

How does Health Information Exchange impact my practice?

Electronic health information exchange (HIE) allows doctors, nurses, pharmacists, other health care providers and patients to access and securely share essential medical information electronically—which has the potential to improve the speed, quality, safety and cost of patient care.

Historically most Americans’ medical information was stored on paper—in filing cabinets at various medical offices, or in boxes and folders in patients’ homes. There has been a tremendous pushover the past several years to digitize the health care experience and to allow for increased accessibility and portability of health information.

Appropriate and timely sharing of vital patient information can better inform decision making at the point of care and allow providers to:

  • Decrease duplicate testing
  • Avoid medication errors
  • Avoid readmissions
  • Improve decision making

An important factor in electronically exchanging health information is the standardization of data. Once standardized, the data transferred can integrate into the recipients' Electronic Health Record (EHR), further improving patient care. There are currently three key forms of health information exchange:

  • Directed Exchange – the ability to send and receive secure information electronically between care providers to support coordinated care
  • Query-based Exchange – the ability for providers to find and/or request information on a patient from other providers, often used for unplanned care
  • Consumer Mediated Exchange – the ability for patients to aggregate and control the use of their health information among providers

From ONC’s Interoperability Roadmap version 1.0, interoperability and information exchange should support the vision of a learning health system:

  • where individuals are at the center of their care;
  • where providers have a seamless ability to securely access and use health information from different sources;
  • where an individual’s health information is not limited to what is stored in electronic health records (EHRs), but
    1. includes information from many different sources (including technologies that individuals use) and
    2. portrays a longitudinal picture of their health, not just episodes of care;
  • where diagnostic tests are only repeated when necessary, because the information is readily available;
  • and where public health agencies and researchers can rapidly learn, develop, and deliver cutting edge treatments.

Download the full ONC Interoperability Roadmap below:

ONC Interoperability Roadmap

Nationwide Interoperability Roadmap

Overview
ONC’s vision for a future health IT ecosystem where electronic health information is appropriately and readily available to empower consumers, support clinical decision-making, inform population and public health and value based payment, and advance science

Who it’s for
Providers and health IT professionals

When it’s used
Throughout the lifecycle of EHR implementation

Download ONC Interoperability Roadmap [PDF - 3.8 MB]

Learn more about the basics about of Health Information Exchange. The following resources are designed to support health information exchange in your practice and community.

What is HIE (Health Information Exchange)?

Overview
Explains health information exchange, its value to providers, and the types of health information exchanges and examples of their use; A video depicting benefits of consumer mediated exchange is included

Who it’s for
Providers and health IT professionals

When it’s used
When educating about health information exchange

Check out the What is HIE (Health Information Exchange)?

Learning Guide: Enabling Health Information Exchange to Support Community Goals

Learning Guide: Enabling Health Information Exchange to Support Community Goals

Overview
Learning guide on implementing HIE to support community goals

Who it’s for
Provider practices, hospitals and health care communities

When it’s used
To educate on how to implement HIE to improve healthcare and increase efficiency of the healthcare delivery system

Download Learning Guide: Enabling Health Information Exchange to Support Community Goals [PDF - 383 KB]

Regional Health eDecisions: A Guide to Connecting Health Information Exchange in Primary Care

Regional Health eDecisions: A Guide to Connecting Health Information Exchange in Primary Care

Overview
A guidebook that addresses the process of connecting EHRs to a regional health information organization (RHIO) and establishing clinical decision support

Who it’s for
Primary care providers that currently or plan to participate in an HIE, HIEs, IT support staff

When it’s used
When seeking guidance on connecting an EHR to a local HIE and/or a regional health information organization (RHIO)

Download Regional Health eDecisions: A Guide to Connecting Health Information Exchange in Primary Care [PDF - 2.84 MB]

The following value propositions for Behavioral Health, Emergency Medical Services (EMS), Long-term and Post-Acute Care (LTPAC) and general provider services are only a few examples that further demonstrate the need for HIE in specific care settings.

HIE Value Proposition: Behavioral Health

HIE Value Proposition: Behavioral Health

Overview
Explains how the use of EHRs and HIE among behavioral health and physical care teams can encourage the bi-directional exchange of critical health data to improve knowledge sharing and health care outcomes. Also includes facts and figures related to benefits of and opportunities for HIE

Who it’s for
Behavioral health providers, physical care teams who work with Behavioral health providers, Health IT professionals

When it’s used
When educating about HIE, and how to exchange information between behavioral health and primary care teams

Download HIE Value Proposition: Behavioral Health [PDF - 542 KB]

HIE Value Proposition: EMS

HIE Value Proposition: EMS

Overview
Explains how the use of HIE can give EMS providers the ability to use full Search, Alert, File, Reconcile (SAFR) functionality. Also includes facts and figures related to benefits of and opportunities for HIE

Who it’s for
EMS providers, Hospital Health IT implementers, critical access hospitals

When it’s used
When educating about HIE and planning to exchange information between EMS and health provider organizations (e.g. hospitals and emergency rooms), public health, and other population health stakeholders

Download HIE Value Proposition: EMS [PDF - 736 KB]

HIE Value Proposition: General Factsheet

HIE Value Proposition: General Factsheet

Overview
Provides background and education on health information exchange and the benefits of HIE in healthcare. Also includes facts and figures related to benefits of and opportunities for HIE

Who it’s for
Health care teams and Health IT professionals

When it’s used
When educating about HIE

Download HIE Value Proposition: General Factsheet [PDF - 599 KB]

HIE Value Proposition: LTPAC

HIE Value Proposition: LTPAC

Overview
Explains how HIE supports care coordination and information exchange in the LTPAC setting. Also includes facts and figures related to benefits of and opportunities for HIE

Who it’s for
LTPAC facilities, Health IT implementers in LTPAC facilities

When it’s used
When educating about HIE, when deciding to implement EHRs in LTPAC settings

Download HIE Value Proposition: LTPAC [PDF - 792 KB]

Summary: Direct secure messaging is used by providers to easily and securely send patient information—such as laboratory orders and results, patient referrals, or discharge summaries—directly to another health care professional. This information is sent over the internet in an encrypted, secure, and reliable way amongst health care professionals who already know and trust each other, and is commonly compared to sending a secured email. This form of information exchange enables coordinated care, benefitting both providers and patients. For example:

  • A primary care provider can directly send electronic care summaries that include medications, problems, and lab results to a specialist when referring their patients. This information helps to inform the visit and prevents the duplication of tests, redundant collection of information from the patient, wasted visits, and medication errors.
  • If laboratory results are received electronically and incorporated into a provider’s EHR, a list of patients with diabetes can be generated. The provider can then determine which of these patients have uncontrolled blood sugar and schedule necessary follow-up appointments.

Directed exchange is also being used for sending immunization data to public health organizations or to report quality measures to The Centers for Medicare & Medicaid Services (CMS).

The following resources are designed to support your efforts to implement direct exchange in your practice and community.

Direct Trust 101

Overview
Online alliance that maintains rules, standards, and policies associated with the operation of the security and trust-in-identity layer for Direct exchange

Who it’s for
Providers currently participating or seeking to support Direct Exchange activities

When it’s used
When seeking information on how Direct Exchange works and the benefits

Visit the Download Direct Trust 101 site

HIE Directed Exchange for Providers

HIE Directed Exchange for Providers

Overview
Provides an introduction to solutions and architectures to enable directed exchange of information to and from provider organizations

Who it’s for
Providers

When it’s used
When educating about directed exchange or seeking answers to key questions about directed exchange

Download HIE Directed Exchange for Providers [PDF - 326 KB]

Interoperability Training Courses

Interactive courses using stories, analogies, and practical examples to highlight new vocabulary, content, transport, and services standards. These training courses also introduce the concept of interoperability building blocks and utilize stories to show concepts in practice.

The series consists of five self-paced courses that allow learners to access the material as their schedule permits, providing flexibility to take the entire course at once or over a period of time.

  • Defining Interoperability
  • Interoperability Path to Meaningful Use Stage 2
  • Building Blocks of Interoperability
  • The Effect of Interoperability on Categories of Care

Interoperability Training Courses

Overview
Provides real-world examples and a story-based approach to highlight the interoperability standards used when implementing health information exchange for transitions of care, lab exchange, patient engagement, and public health measures

Who it’s for
Eligible professionals, eligible hospitals, health IT implementers

When it’s used
When preparing to meet Stage 2 Meaningful Use objectives in these areas

Visit the Interoperability Training Courses site

Interoperability Standards Advisory (ISA)

Overview
“Best available” interoperability standards and implementation standards for industry use to fulfill specific clinical health IT interoperability needs

Who it’s for
Health IT professionals, healthcare information exchange organizations, providers, public health organizations

When it’s used
When planning for and developing software applications required to meet national standards for clinical health information exchange

Visit the Interoperability Standards Advisory (ISA) site

Other Forms of Health Information Exchange

QUERY-BASED EXCHANGE

Query-based exchange is used by providers to search and discover accessible clinical sources on a patient. This type of exchange is often used when delivering unplanned care. For example:

  • Emergency room physicians who can utilize query-based exchange to access patient information—such as medications, recent radiology images, and problem lists—might adjust treatment plans to avoid adverse medication reactions or duplicative testing.
  • If a pregnant patient goes to the hospital, query-based exchange can assist a provider in obtaining her pregnancy care record, allowing them to make safer decisions about the care of the patient and her unborn baby.

CONSUMER-MEDIATED EXCHANGE

Consumer-mediated exchange provides patients with access to their health information, allowing them to manage their health care online in a similar fashion to how they might manage their finances through online banking. When in control of their own health information, patients can actively participate in their care coordination by:

  • Providing other providers with their health information
  • Identifying and correcting wrong or missing health information
  • Identifying and correcting incorrect billing information
  • Tracking and monitoring their own health

ADT messages are the vehicle for communicating updates about a patient’s care transitions. The messages provide each patient’s personal or demographic information (such as the patient’s name, insurance, next of kin, and attending physician) and when that information has been updated. They also indicate when an ADT status (e.g., admitted, discharged) has changed.

  • The alerts are triggered by an admission, discharge, or transfer (ADT) event in a hospital information system that sends a message to the health information exchange system.
  • The HIE system processes the message and transforms it into an alert sent to the primary care practice or community-based care manager.
  • This communication notifies the physician, care manager or care management team to initiate an intervention, improving the post-discharge transition, and supports management of patients with chronic conditions.

Learning Guide: Improving Hospital Transitions and Care Coordination Using Automated Admission, Discharge and Transfer (ADT) Alerts

Learning Guide: Improving Hospital Transitions and Care Coordination Using Automated Admission, Discharge and Transfer (ADT) Alerts

Overview
A learning guide that teaches how Automated Admission, Discharge and Transfer (ADT) Alerts can help improve hospital transitions and care coordination; it assembles knowledge and lessons learned on automated ADT alert systems

Who it’s for
Hospitals

When it’s used
When educating about opportunities and the value of exchanging ADT information with HIEs

Download Learning Guide: Improving Hospital Transitions and Care Coordination Using Automated Admission, Discharge and Transfer (ADT) Alerts [PDF - 386 KB]

Summary: Tools and resources to support the movement or referral of patient from one setting of care to another and/or from one provider to another in a course of treatment or ongoing care management.

A transition of care is the movement of a patient from one provider or clinical setting of care to another provider or setting of care. For example, a transition of care occurs when a primary care provider (PCP) refers a patient to a specialist, or when a hospital discharges a patient to another care setting. In many cases, but not all, a transition of care is permanent. For example, when a provider discharges a patient from an inpatient setting, the discharging provider expects that the patient will not return. When a PCP refers a patient to a specialist, such a referral is a transition of care; however, the PCP typically expects the patient to return for subsequent follow-up care.

A patient’s transition in care presents sending and receiving providers an important opportunity to exchange patient information and reduce gaps in care. Having relevant patient information available when a patient transitions enables providers to reconcile medications and other clinical information when patients are sent to their new setting.

TOC Measures in the Stage 2 Summary of Care Objective

TOC Measures in the Stage 2 Summary of Care Objective

Overview
Explains transition of care measures in Stage 2 Summary of Care objectives and the options for achieving them

Who it’s for
Eligible professionals, eligible hospitals, critical access hospitals

When it’s used
When preparing to meet Stage 1 menu and Stage 2 core Meaningful Use requirements to achieve Summary of Care Objective

Download TOC Measures in the Stage 2 Summary of Care Objective [PDF - 395 KB]

Summary: Standards, in the context of health IT, refer to agreed-on file formats for electronic documents, messages, and other healthcare related data elements. These standard formats allow for the creation of electronic messages that are exchanged between different health IT systems, which make interoperability and health information exchange possible.

There are many types of health standards and they are often used in varying levels within health IT systems. Here are a few common types of standards: The standards and associated implementation specifications for clinical health information are grouped into four categories:

  • Terminology standards: Terminology standards specify which terms are to be used in a particular clinical domain and how each term in the system is defined (e.g., “weight” versus “birth weight” versus “dosing weight”). Terminology standards also define the vocabulary or code sets that pertain to a particular clinical domain or data type.
  • Content standards: Content standards define the structure for information that may be packaged for exchange (i.e., syntax). Content standards may define the data to be included, define the document structure, or include metadata about the information to be exchanged.
  • Transport standards: Transport standards specify how data are to be packaged and transported between systems. Successful transport between systems leads to the ability of disparate systems to work together (interoperability). Transport standards often define “how” information is exchanged (i.e., the method by which information is moved from point A to point B).
  • Services standards: Services standards specify the infrastructure components deployed and used to accomplish specific information exchange objectives (e.g., standards and specifications for how information may be “pushed” to a known destination or specifications for how to query for a document)

Other standards include security standards and process standards that are typically not unique to healthcare such as security standards for accessing the internet or process or quality standards for ensuring products or services consistently meet customer requirements.

Successful exchange of electronic messages comprised of above standards between systems leads to the ability of disparate systems to work together (interoperability).

Standards/SDO Training Module

Standards/SDO Training Module

Overview
Information about what standards are, how they are used, and the Standards Development Organizations that develop and maintain standards

Who it’s for
Providers, health IT implementers

When it’s used
When seeking information about a specific standard or SDO, or when you are having a problem with the implementation of a standard

Check out the Standards Training Module

Section 3 Recap

Share information securely with electronic health information exchange.

  • Send patient information securely
  • Leverage automatic alerts
  • Facilitate transitions of care
  • Follow health IT standards

Join the conversation.

Let us know how we can improve and expand on Health Information Exchange.

Content last updated on: January 23, 2017