Health Information Exchanges: How They Work and What You Can Do to Participate

By Tara Gensemer, CAHIMS; Practice Support Specialist for PAMED’s Practice Support Team

Health-Information-Exchange-1Coordination of care, closing care gaps, value-based payment models: How can a clinician address the ever-changing health care environment while decreasing overhead and maximizing efficiency? 

One solution is a Health Information Exchange (HIE) – technology which can streamline the process of information flow in and out of a practice.

What Is a Health Information Exchange?

An HIE is a secure exchange of health information between physicians, nurses, pharmacists, and other health care providers. HIEs aim to:

  • Ensure continuity of care
  • Avoid medical and medication errors
  • Decrease duplicate procedures or testing
  • Provide a complete medical record, verify medication, patient history
  • Provide timely access to patient data
  • Support patient safety
  • Support physicians for unplanned care by helping them query the exchange for medication allergies, problem lists, and recent tests
  • Reduce costs for your practice and patients

An HIE can paint a more complete picture for patient care as well as reduce staff research time. By querying your HIE or simply receiving data directly into an integrated electronic health record (EHR), your practice could be receiving information such as medication lists; patient history; admission, discharge, and transfer (ADT) reports; or procedure notifications. Medical decision-making is supported with a more complete medical record, and a patient is spared additional time and money by avoiding redundant or duplicate procedures and testing.

One area where an HIE can help improve efficiency is transition of care management, which mandates patient follow-up 24 to 48 hours after discharge from a hospital or emergency department to reduce readmission rates. “We are following up after every ADT, contacting every patient,” says William Artz, DO, of Associated Family Practice Professionals, PC, and HealthShare Exchange participant.

“Almost everyone comes in. Patients think it is awesome that we have that kind of access in order to care for them. We have had to change our workflow, setting aside a block of appointments, to capture patients discharged from the hospital and ED.”

Additional benefits to participation in an HIE include the assistance in quality reporting. Patient queries could result in closing a gap in care, or indicate patient non-compliance. In some cases, locating information to close the gaps could be as easy as a few clicks of a mouse.

How to Get Started with an HIE: A Checklist

MACRA-ChecklistStep one in HIE participation is asking questions. Here is a checklist that may be helpful when you are making decisions regarding your HIE:

1. What degree of collaboration does your HIE provide?

  • Can it be integrated with my EHR?
  • Is the HIE browser-based?

2. Does the HIE offer Direct Secure Messaging between providers? 

3. What data is protected when I query the system?

  • Would it include minors?
  • Will it exchange sensitive information (super-protected information)?

4. Which exchange service providers are available in my area?

5. Talk with your service providers.

  • Ask about sustainability.
  • What are the internal requirements of your practice to participate in an exchange?
  • Does the HIE have a dedicated team to support provider/practice training and education?
  • Is marketing material and patient education provided?
  • What are the fees associated with joining? Start up, monthly, annual?
  • What are the risks and liability?
  • What forms of exchange? FHIR or HL7?

6. Talk with your EHR vendor.

  • What are the fees associated with integration?
  • Do they offer interoperability?
  • What is the estimated timeline of integration?
  • Privacy and security?
  • Maintenance fees?

Participation in an HIE begins with support from your staff. As the HIE is integrated into your practice, staff will recognize workflow should be updated to reflect the use of the new tool. The exchange of electronic secure data will not only enable your practice to save time and money, but aid in satisfaction from patients and staff. Information received from an HIE data push or pull creates a longitudinal patient record readily available to interpret and improve treatment, provide solutions, and advance processes.

Additional Resources

This article is the first part of a two-part Pennsylvania Medical Society (PAMED) series on Health Information Exchanges. Get details on the four HIEs currently operating in Pennsylvania in Part 2 of PAMED’s HIE article here.

For more information regarding HIEs, please visit these websites:

PAMED members with questions can also contact our Knowledge Center at 855-PAMED4U (855-726-3348) or KnowledgeCenter@pamedsoc.org.

A version of this article appeared in the winter 2018 issue of Pennsylvania Physician Magazine, PAMED’s print magazine, and was reprinted with permission.


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