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

Section 3

Health Information Exchange

How does Health Information Exchange affect your practice?

Electronic health information exchange allows doctors, nurses, pharmacists, other health care providers, and patients to access and securely share essential medical information electronically. This 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 push over 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 better informs decision-making at the point of care and allows providers to:

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

Standardizing data is an important factor in electronically exchanging health information. Once standardized, the transferred data can be integrated into the recipients' electronic health record (EHR), further improving patient care. There are currently 3 key forms of health information exchange:

A Shared Interoperability Roadmap

Nationwide Interoperability Roadmap

As outlined in “A Shared Interoperability Roadmap,” 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 isn’t limited to what’s stored in an EHR
    • Where an individual’s information comes from many different sources (including technologies that individuals use)
    • Where an individual’s information portrays a longitudinal picture of their health, not just episodes of care
  • Where diagnostic tests are repeated only when necessary, because the information’s readily available
  • Where public health agencies and researchers can rapidly learn, develop, and deliver cutting edge treatments

Overview
A vision for an interoperable health IT ecosystem that makes electronic health information appropriately and readily available. Such an ecosystem would empower consumers, support clinical decision-making, inform population- and public-health policy, promote value-based payment, and advance science

Who it’s for
Providers and health IT professionals

When it’s used
To use throughout the EHR implementation lifecycle

Download A Shared Interoperability Roadmap [PDF - 3.8 MB]

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

What is Health Information Exchange?

Overview
Explains the value of health information exchange to providers, the types of health information exchange services and examples of their use; includes a video depicting the benefits of Consumer-mediated Exchange

Who it’s for
Providers and health IT professionals

When it’s used
To educate individuals about health information exchange

Learn more at the health information exchange webpage

Learning Guide: Enabling Health Information Exchange to Support Community Goals

Learning Guide: Enabling Health Information Exchange to Support Community Goals

Overview
A learning guide designed to increase the exchange (or flow) of health information to support community goals

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

When it’s used
To teach how health information exchange can improve health care and increase the efficiency of the health-care 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
This guide addresses the process of connecting an EHR 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 a health information exchange, and IT support staff

When it’s used
To learn how to connect an EHR to a local health information exchange organization and/or to an RHIO

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

Bright Spot

Using Health Information Exchange to Improve Care Coordination for Newborn Hearing Screening

Can clinical health information exchange improve communication, early intervention, and care coordination in your area? Learn how health care organizations in Utah worked together using clinical health information exchange to support state-wide infant-hearing screening.

Download Using Health Information Exchange to Improve Care Coordination for Newborn Hearing Screening [PDF - 828 KB]

Download Using Health Information Exchange (HIE) to Improve Care Coordination for Newborn Hearing Screening. PDF, 828kb

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.

The Value Proposition of Health Information Exchange: Behavioral Health

HIE Value Proposition: Behavioral Health

Overview
Explains how the use of EHR and health information exchange services among behavioral-health and physical-care teams encourages the bi-directional exchange of critical health data to improve knowledge-sharing and health-care outcomes. Also includes statistics related to the benefits of, and opportunities for, exchanging health information

Who it’s for
Behavioral-health providers, the physical-care teams who work with them, and health IT professionals

When it’s used
To teach about health information exchange and to learn how to exchange information between behavioral-health and primary-care teams

Download the Value Proposition of Health Information Exchange: Behavioral Health [PDF - 542 KB]

Bright Spot

Expanding Behavioral Health Information Exchange for Providers in Washtenaw County, Michigan

Can health information exchange improve care coordination in other health care settings? Learn how Washtenaw County Community Mental Health developed an electronic patient-consent management system to improve care coordination with health care providers, other mental health agencies, and community stakeholders.

Download Expanding Behavioral Health Information Exchange for Providers in Washtenaw County, Michigan [PDF - 1.8 MB]

Download Expanding Behavioral Health Information Exchange for Providers in Washtenaw County, Michigan. PDF, 1.8mb

The Value Proposition of Health Information Exchange: EMS

HIE Value Proposition: EMS

Overview
Explains how health information exchange services can give EMS providers the ability to use full Search, Alert, File, Reconcile (SAFR) functionality. Also includes statistics related to the benefits of, and opportunities for, health information exchange

Who it’s for
EMS providers, hospital health IT implementers, and Critical Access Hospitals (CAH)

When it’s used
To teach about health information exchange and to plan information exchange between EMS, hospitals and emergency rooms, public health, and other population health stakeholders

Download the Value Proposition Health Information Exchange: EMS [PDF - 736 KB]

EMS and Health Information Exchange: SAFR EMS Health Information Exchange Integration Model

HIE Value Proposition: EMS

Overview
A resource highlighting how emergency medical services (EMS) and health information exchange organizations can work together to improve data sharing. It also explains the search, alert, file, reconcile (SAFR) model of health information exchange and profiles 5 communities working to integrate EMS and health information exchange

Who it’s for
EMS providers, hospital health IT implementers, and health information exchange organizations

When it’s used
To learn about the benefits of coordinating EMS and health information exchange, and to learn about SAFER and how 5 communities are implementing that health information exchange model

Download the SAFR EMS Health Information Exchange Integration Model [PDF - 857 KB]

The Value Proposition of Health Information Exchange: LTPAC

The Value Proposition of Health Information Exchange: LTPAC

Overview
Explains how health information exchange supports care coordination and information exchange in the LTPAC setting. Also includes statistics related to the benefits of, and opportunities for, exchanging healthcare information

Who it’s for
LTPAC facilities and health IT implementers in LTPAC facilities

When it’s used
To teach about health information exchange; to implement EHRs in LTPAC settings

Download the Value Proposition of Health Information Exchange: LTPAC [PDF - 792 KB]

The Value Proposition of Health Information Exchange: General Fact Sheet

The Value Proposition of Health Information Exchange: General Fact Sheet

Overview
Provides background and education on health information exchange and the benefits of health information exchange in health care. Also includes statistics related to the benefits of, and opportunities for, exchanging health care information

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

When it’s used
To teach about health information exchange

Download the Value Proposition of Health Information Exchange: General Fact Sheet [PDF - 599 KB]

Providers use Directed Exchange to easily and securely send patient information — such as laboratory orders and results, patient referrals, or discharge summaries — directly to another health care professional.

Health care professionals, who already know and trust each other, send this information over the internet in an encrypted, secure, and reliable way; it’s commonly compared to sending a secured email. This form of information exchange enables coordinated care that benefits both providers and patients.

A primary care provider can, for example, 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:

  • Duplication of tests
  • Redundant collection of patient information
  • Wasted visits
  • Medication errors

If a provider receives laboratory results electronically and incorporates them into an electronic health record (EHR) they can, for example, generate a list of patients with diabetes. The provider can then determine which of these patients have uncontrolled blood sugar and schedule necessary follow-up appointments.

Providers also use Directed Exchange to send immunization data to public health organizations, or to report quality measures to The Centers for Medicare & Medicaid Services (CMS).



The following resources will support your efforts to implement Directed Exchange in your practice and community.

Direct Trust 101

Overview
This online alliance maintains rules, standards, and policies associated with the operation of the security and trust-in-identity layer for Directed Exchange

Who it’s for
Providers currently participating in, or seeking to support, Directed Exchange

When it’s used
To learn how Directed Exchange works and about the benefits it provides

Visit the Download Direct Trust 101 site

Health Information Exchange: Directed Exchange for Providers

Health Information Exchange: Directed Exchange for Provider

Overview
Introduces solutions that enable Directed Exchange of information between provider organizations

Who it’s for
Providers

When it’s used
To teach about Directed Exchange or to learn more about Directed Exchange

Download Health Information Exchange: Directed Exchange for Providers [PDF - 326 KB]

Interoperability Training Courses

The following interactive courses include 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 use stories to show concepts in practice.

The series consists of 5 self-paced courses that let you access the material as your schedule permits, providing the flexibility to take the entire course at once or over time. Topics include:

  • 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 to implement health information exchange for transitions of care, lab exchange, patient engagement, and public health measures

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

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

Visit the Interoperability Training Courses website

Interoperability Standards Advisory (ISA)

Overview
The “best available” interoperability standards and implementation standards to fulfill specific clinical health IT interoperability needs

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

When it’s used
To plan for and develop software applications required to meet national standards for clinical health information exchange

Visit the Interoperability Standards Advisory (ISA) website

Other forms of health information exchange

Query-based Exchange

Providers use Query-based Exchange to search and discover accessible clinical sources on a patient. Providers often use this type of exchange to deliver unplanned care. For example:

  • Emergency room physicians who use 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 duplicate tests
  • If a pregnant patient goes to the hospital, Query-based Exchange can help a provider obtain her pregnancy care record, allowing them to make safer care decisions — for both the patient and her unborn baby

Consumer-mediated Exchange

Consumer-mediated Exchange provides patients with access to their health information online. This lets them manage their health care similar to how they might manage their finances through online banking. When they control their own health information, patients can actively participate in their care coordination and:

  • Give other providers their health information
  • Identify and correct wrong or missing health information
  • Identify and correct inaccurate billing information
  • Track and monitor their own health

Admission, discharge, or transfer (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 name, insurance, next of kin, and attending physician) and notes when that information has been updated. They also indicate when an ADT status has changed — an admission or discharge, for example. Here’s how ADT alerts work:

  • 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 health information exchange 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, thus improving the post-discharge transition and supporting 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 guide that teaches how ADT alerts can help improve hospital transitions and care coordination; a collection of knowledge and lessons learned on automated ADT alert systems

Who it’s for
Hospitals

When it’s used
To learn about the opportunities and value of exchanging ADT information with health information exchange organizations

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

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 gives both the 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 lets providers reconcile medications and other clinical information when patients transfer 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, and Critical Access Hospitals (CAH)

When it’s used
To prepare 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]

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 4 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 (syntax) for information that may be packaged for exchange. 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 (the method by which information moves from point A to point B).

Services standards: Services standards specify the infrastructure components deployed and used to accomplish specific information exchange objectives (for example, 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 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 — using standards listed above — 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’re used, and the Standards Development Organizations (SDO) that develop and maintain standard

Who it’s for
Providers and health IT implementers

When it’s used
To find information about a specific standard or SDO, or when you’re having a problem implementing 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: May 31, 2017