Health information exchange (HIE)

Health information exchange is defined as the mobilization of healthcare information electronically across organizations within a region or community.

HIE provides the capability to electronically move clinical information between disparate health care information systems while maintaining the meaning of the information being exchanged. The goal of HIE is to facilitate access to and retrieval of clinical data to provide safer, more timely, efficient, effective, equitable, patient-centered care.

Formal organizations are now emerging to provide both form and function for health information exchange efforts. These organizations (often called Regional Health Information Organizations, or RHIOs) are ordinarily geographically-defined entities which develop and manage a set of contractual conventions and terms, arrange for the means of electronic exchange of information, and develop and maintain HIE standards.

History
Some of the oldest RHIO's actually date back to the 1990s. The eHealth Initiative ranks the Indiana HIE as the most advanced and successful.

In 1994, with funding from the National Institutes of Health and the National Library of Medicine, the Regenstrief Institute Medical Informatics division extended the RMRS to the Indiana Network for Patient Care (INPC), a city-wide clinical informatics network.

All INPC participants now deliver registration records, all laboratory tests, and all UB92 records (diagnosis, length of stay, and procedure codes) for hospital admissions and emergency room visits to separate electronic medical record vaults in a central INPC server located at Wishard Hospital. The message exchange standard that is used is HL7. The computer system standardizes all clinical data as it arrives at the INPC vault, laboratory test results are mapped to a set of common test codes LOINC with standard units of measure, and patients with multiple medical record numbers are linked. Each institution has the same file structure and shares the same term dictionary which contain the codes, names (and other attributes) for tests, drugs, coded answers, etc. When a patient is seen in any of the 11 emergency rooms operated by the consortium hospitals, and the patient consents, the information from all of these institutions about one patient can be presented as one electronic medical record.

One of the largest, actively functioning, and few self-sustaining Health Information Exchanges involves the same group of medical informaticists from the Regenstrief Institute in collaboration with the major hospital systems in the region. It is called the Indiana Health Information Exchange. The first services delivered by IHIE include electronic delivery of test reports to physician offices using faxes, printers, or an electronic/ web based mail box (DOCS4DOCS Clinical Messaging System). According to their own website, their aim is to:
 * Improve the quality, safety, and efficiency of health care in the state of Indiana ,
 * Create unparalleled research capabilities for health researchers,
 * Exhibit a successful model of health information exchange for the rest of the country.

To get a customer's perspective on the use of a HIE see the Medical Economics article: "Why these doctors love their RHIO"

Peer reviewed commentary on the value of a HIE and how HIE are intimately related to quality health care

Additional Communities
See the eHealth Initiative Directory for profiles of all major regional HIE efforts.

Big Bend RHIO: The BBRHIO is a 501.C3 not for profit Florida Corporation that aims to deliver an enhanced level of patient centered care. Surrounding rural communities will benefit from the improvements and efficiencies created by the BBRHIO efforts. Tallahassee, Florida.

HealthBridge: Southwest Ohio, North Central Kentucky and South Eastern Indiana Regions.

Indiana Health Information Exchange: The Indiana Health Information Exchange (IHIE) provides several health information exchange services throughout the state of Indiana. One of the oldest and largest health information exchanges across the country, IHIE provides a clinical messaging result delivery service and a clinical quality improvement services called Quality Health First(tm}

Jacksonville Health Information Network: The Jacksonville Health Information Network (JHIN) is one of the three complementary strategies JaxCare, Inc. is pursuing to improve the healthcare access and delivery of Jacksonville's uninsured and underinsured. The Jacksonville Health Information Network infrastructure will allow physicians and the medical staff of hospitals and clinics serving the uninsured to access the network to check for available health records in a secure manner. Jacksonville, Florida

MA-SHARE: Massachusetts SHARE (Simplifying Healthcare Among Regional Entities) is a regional collaborative initiative operated by the Massachusetts Health Data Consortium. MA-SHARE seeks to promote the inter-organizational exchange of healthcare data using information technology, standards and administrative simplification, in order to make accurate clinical health information available wherever needed in an efficient, cost-effective and safe manner.

Mendocino HRE - Mendocino Co. California

The MidSouth eHealth Alliance: The MidSouth eHealth Alliance is a community wide information system that helps health care providers in the treatment of patients. Providers are as doctors, nurses, healthcare workers, hospitals, and clinics. The MidSouth eHealth Alliance is based in Memphis, TN.