Health information exchange
Health information exchange (HIE) 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 careinformation 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. [http://www.jamia.org/cgi/content/abstract/M1680v1]
Some of the oldest RHIO's actually date back to the 1990s. The [http://ccbh.ehealthinitiative.org/profiles/Regenstrief_Institute.mspx eHealth Initiative] ranks the [http://www.ihie.org Indiana HIE] as the most advanced and successful.
In 1994, with funding from the [http://www.nih.gov National Institutes of Health] and the [http://www.nlm.nih.gov/ 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. [http://www.regenstrief.org/medinformatics/inpc/]
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 LOINCwith 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. [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1480174]
One of the largest, actively functioning, and few self-sustaining Health Information Exchanges involves the same group of medical informaticists from the [http://www.regenstrief.org/ Regenstrief Institute] in collaboration with the major hospital systems in the region. It is called the [http://www.ihie.com/ 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 [http://www.ihie.org 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.
The Michiana Health Information Network located in northern Indiana was established in 1999. Since its inception the exchange has been able to successfully operate without grant funding as is self sustaining today. The network provides electronic result delivery with push technology, interface services for physician practices EHRs and institutional software, it's own electronic health record and a series of products supporting clinical registries and health quality improvement. MHIN is dedicated to the improvement of care and the reduction of medical cost in the Michiana community.
To get a customer's perspective on the use of a HIE see the [http://www.memag.com/memag/ Medical Economics] article: " [http://www.memag.com/memag/article/articleDetail.jsp?id=182803 Why these doctors love their RHIO] "
Peer reviewed commentary on the value of a HIE [http://content.healthaffairs.org/cgi/content/full/hlthaff.w5.10/DC1] and how HIE are intimately related to quality health care [http://www.ahqa.org/pub/uploads/QIO_HIE_Final_Report_March_6_2006.pdf]
See the [http://ccbh.ehealthinitiative.org/profiles/default.mspx eHealth Initiative Directory] for profiles of all major regional HIE efforts.
[http://www.bbrhio.org/ 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.
[http://www.healthbridge.org/ HealthBridge] :Southwest Ohio, North Central Kentucky and South Eastern Indiana Regions.
[http://www.ihie.org/ 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 [http://www.qualityhealthfirst.org Quality Health First(tm}]
[http://www.jaxcare.org/infrastructure_rev_1072.aspx 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
[http://www.mahealthdata.org/ma-share/ 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.
[http://www.redwoodmednet.org/index.html Redwood MedNet HIE] :Redwood MedNet, located in Mendocino County, California, is a community based nonprofit 501(c)(3) organization operating a clinical results delivery service in a thinly populated 5,000 square mile rural region on the north Pacific coast.
[http://www.midsoutheha.org/ 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.
[http://www.mhin.com/ Michiana Health Information Network] :The Michiana Health Information Network is a health information exchange that support institutions and health care providers and clinicians in northern Indiana and southwestern Michigan. The mission of the exchange is the overal improvement of care and reduction of healthcare costs in the communities they serve.
Regional Health Information Organization(RHIO)
HealthUnity- A provider of HIE products and services.
* [http://www.regenstrief.org/medinformatics/inpc/ Regenstrief INPC]
* [http://ccbh.ehealthinitiative.org/profiles/Regenstrief_Institute.mspx eHealth Initiative on Regenstrief]
* [http://www.jamia.org/cgi/content/abstract/M1680v1 Communities' Readiness for Health Information Exchange: The National Landscape in 2004- JAMIA 2004 Article on RHIO's or HIE's]
* [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1480174 Community Clinical Data Exchange for Emergency Medicine Patients- AMIA Proceedings Article from 2003]
* [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=385298&tools=bot Indianapolis I3: the third generation Integrated Advanced Information Management Systems- J Med Libr Assoc. 2004 April; 92(2): 179–187.]
* [http://content.healthaffairs.org/cgi/content/full/hlthaff.w5.10/DC1 The Value Of Health Care Information Exchange And Interoperability- Health Affairs 2005]
* [http://www.ahqa.org/pub/uploads/QIO_HIE_Final_Report_March_6_2006.pdf Quality Improvement Organizations and Health Information Exchange]
* eHealth Initiative, Second Annual Survey of State, Regional and Community-based Health Information Exchange Initiatives and Organizations, August, 2005
* [http://www.ihie.com/ Indiana Health Information Exchange]
* [http://www.jaxcare.org/infrastructure_rev_1072.aspx Jacksonville Health Information Network (JHIN)]
* [http://www.regenstrief.org/medinformatics/inpc/ Indiana Network for Patient Care]
* [http://www.healthunity.com/handbook_main.aspx Health Information Exchange / RHIO Reference Handbook]
* [http://www.mendocinohre.org/index.html Mendocino HRE (Health Records Exchange)]
* [http://www.mahealthdata.org/ma-share/ MA-SHARE]
* [http://www.ehealthinitiative.org eHealth Initiative]
* [http://www.govhealthit.com/article97074-12-11-06-Web RHIOs will lead next phase of NHIN program]
* [http://www.chcf.org California HealthCare Foundation]
* [http://www.healthunity.com/hvm Health Information Exchange value calculation]
* [http://nhinwatch.com/ Nationwide Health Information Network - Current News | NHIN Watch]
* [http://www.hhs.gov/healthit/healthnetwork/ HHS Health Information Technology]
* [http://www.nahit.org/cms/ National Alliance for Health Information Technology (NAHIT)]
* [http://www.mc.vanderbilt.edu/vcbh/ The Vanderbilt Center for Better Health]
* [http://www.markfrisse.com/policy/ Mark Frisse's Policy Blog]
* [http://www.fdhc.state.fl.us/dhit/FHIN/FHIN_White_Paper_Ver6.2_03222007.pdf Florida Health Information Network White Paper
* [http://www.mhin.com/ Michiana Health Information Network (March 2007)]
* [http://www.himss.org/ASP/topics_rhio.asp HIMSS information about HIE and RHIO]
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