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

Section 3

Health Information Exchange

In this section

Learn how:

How does Health Information Exchange affect your practice?

Over the past decade, hospitals and physician offices have made tremendous gains in shifting their medical record-keeping from paper to computerized systems. This shift to electronic health information and interoperability of this information, such as through the use of electronic health records (EHRs), has the potential to make care safer and more efficient and improve the patient care experience by providing timely access to health information and seamlessly coordinated care.

In an ideal state, patients’ information should automatically follow them to all of their health care providers, so that everyone on their care teams stays informed and provides the best treatment. Facilitating electronic exchange of this health information is critical to easing burden by ensuring that clinicians have the best information possible when making decisions about patient care.

Appropriate and timely sharing of patient information also allows clinicians to ensure patients receive timely care in the most appropriate setting by:

  • Reducing duplicate testing
  • Avoiding medication errors
  • Avoiding readmissions
  • Improving decision making
  • Enhancing care coordination

What is being done to improve health information exchange and advance interoperability?

The transition to EHRs has caused frustration among clinicians who expected the electronic capture of information to make their care more efficient. Instead, many clinicians have faced increased workload and patients' and other clinicians' access to the data is not seamless. To address these challenges and improve health information exchange — most notably, in relation to nationwide interoperability and information blocking — Congress passed the 21st Century Cures Act of 2016 (known as “the Cures Act”) with bipartisan support.

Specifically, the Cures Act identified the following main priorities for improved interoperability:

  • Improve data sharing across disparate networks
  • Reduce information blocking
  • Advance a trusted exchange framework and a common agreement for exchange between health information networks nationally
  • Promote the use of APIs to support patients' ability to have greater access to their health information through, for example, smartphones

The provisions of the Cures Act aim to reduce clinicians' regulatory and administrative burden and, in the words of National Coordinator for Health IT Donald Rucker, MD, create “a health system where information flows appropriately and securely to patients and their clinicians [that] will help coordinate care and reduce costs by making care faster and less duplicative.”

What is the Trusted Exchange Framework and Common Agreement (TEFCA)?

The Trusted Exchange Framework and the Common Agreement will outline a policy and technical approach for nationwide electronic health information exchange. TEFCA is mandated as part of the 21st Century Cures Act. Once finalized, it will allow clinicians and other health care providers to access patient health data from a variety of health information networks (HINs).

Health care practices will only have to connect to 1 HIN in order to access patient information from HINs across the country. Being able to access this information can ensure patient safety and better care quality — especially when providing unplanned care.

To participate in health information exchange through the Trusted Exchange Framework and the Common Agreement, health care providers can:

  • Join an existing qualified health information network (QHIN) or join with other practices to form a new QHIN
  • Require that health IT developers they contract with be connected to the network created by the Common Agreement

Learn more about TEFCA.

Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs

Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs

Overview
Identifies challenges to using health IT and EHRs and recommendations for addressing these challenges

Who it’s for
Federal agencies and health IT stakeholders

When it’s used
To create policies and practices that will reduce clinician burden associated with health IT and EHRs

Download Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs [PDF – 1.6 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.

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 clinicians 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

Health Information Exchange Guide

Overview
Online resource with modules on how health information can be exchanged electronically between multiple clinicians and the potential for this to improve safety, quality, and efficiency in health care

Who it’s for
Clinicians, hospitals, and health IT implementers

When it’s used
To identify health information exchange challenges and develop solutions to successfully integrate the technology into an organization

Visit the Health Information Exchange Guide website

The Value Proposition of Health Information Exchange: Behavioral Health

HIE Value Proposition: Behavioral Health

Overview
A fact sheet on 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 clinicians, 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 Clinicians 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 clinicians, other mental health agencies, and community stakeholders.

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

Download Expanding Behavioral Health Information Exchange for Clinicians 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 clinicians 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 clinicians, 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 clinicians, 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]

How do Application Programming Interfaces (APIs) support health information exchange and interoperability?

APIs are technology that allow one software program to access the services provided by another software program. APIs hold the ability to revolutionize health care data sharing, as it has already revolutionized data sharing in other sectors such as the financial and airline industries. Online and smart phone banking are enabled by APIs. APIs can also help health care professionals improve and simplify care delivery in a number of ways.

  • Using APIs as part of EHRs can make it easier for patients to get and share important health information.
  • APIs can also help health care providers share patient information with other providers securely and efficiently.
  • They may also enable clinicians to more easily exchange information for other purposes. For instance, clinicians may use a smartphone app to submit data to a registry in support of public health or quality reporting.

Explore these resources to learn more about APIs:

Clinicians 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 clinicians and patients.

A primary care clinician 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 clinician 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 clinician can then determine which of these patients have uncontrolled blood sugar and schedule necessary follow-up appointments.

Clinicians 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
Clinicians 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

Directed Exchange: Q&A for Providers

Directed Exchange: Q&A for Providers

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

Who it’s for
Clinicians

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

Download Directed Exchange: Q&A for Providers [PDF - 141 KB]

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 clinician or clinical setting of care to another clinician or setting of care. For example, a transition of care occurs when a primary care clinician (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 clinician discharges a patient from an inpatient setting, the discharging clinician 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 clinicians an important opportunity to exchange patient information and reduce gaps in care. Having relevant patient information available when a patient transitions lets clinicians reconcile medications and other clinical information when patients transfer to their new setting.

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).



Learn more about how health IT standards are developed and maintained by Standards Development Organizations (SDOs).

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, clinicians, 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

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
Clinicians 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.

  • Use APIs to support access to health information
  • Send patient information securely
  • Leverage automatic alerts
  • Facilitate transitions of care
  • Follow health IT standards

Join the conversation.

Do you have a tip or suggestion for using electronic health information exchange that's worked well in your practice? Share it here!

Content last updated on: May 31, 2019