http://www.csun.edu/~dn58412/IS531/IS531_SP15.html

Lecture 7Health Information Exchanges

(Chapter 17)

Learning ObjectivesLearning Objectives

1. Health Information Exchanges (HIE) and Users

2. Key Factors in HIE3. HIE Business Models4. Driving Forces for HIE Development5. Obstacles to HIE Development

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Health Information ExchangeHealth Information Exchange

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Health Information ExchangeHealth Information Exchange

• Electronic movement of health-related information among organizations,

• A process within a state health information organization or a regional health information organization

• A bidirectional sharing of patient health-related information among providers and other authorized healthcare professionals

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National Health Information National Health Information NetworkNetwork

• NHIN provides a standardized, secure, and confidential way to link information systems together for authorized users to share reliable health-related information

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Users of Health Information Users of Health Information ExchangesExchanges

• Individual level: enhance personal health outcomes

• Professional level: clinical decision making• Agency/organization level : managing

operations and quality improvement• Public health and national level:

accreditation bodies to evaluate population health, health policy

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Architecture of Architecture of Heath Information ExchangesHeath Information Exchanges

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Key Issues in Key Issues in Heath Information ExchangesHeath Information Exchanges

• Data storage• Master person index (MPI)• Record locator service• Authentication• Authorization• Security policies• Auditing and logging• Standards• Scope of services • Knowledge of workflow• Portals for access

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Data StorageData Storage

• To enable the aggregation of data from many sources

• Infrastructure models– Centralized– Decentralized / federated– Hybrid

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Centralized Data StorageCentralized Data Storage

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Decentralized Data StorageDecentralized Data Storage

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Hybrid Data StorageHybrid Data Storage

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Master Person Index (MPI)Master Person Index (MPI)

• To uniquely identify an individual• To match the person’s data from many

sources• Could be a complex identifier with

multiple identification attributes (name, DOB, address)

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Record Locator ServiceRecord Locator Service

• A service to search health information that matches the identified individual

• Locator can point to a specific types of information / criteria

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AuthenticationAuthentication

• To identify authentic users to the systems• Valid users: clinical professionals, public

health professionals, supporting IT professionals

• Will include patients in future

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AuthorizationAuthorization

• Authorized user matrix: WHO can access WHAT information for WHAT purpose

• CRUD Function Matrix in database: Create-Read-Update-Delete

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Security Policies & ProceduresSecurity Policies & Procedures

• Agreement among organizations to share patient data (retrieve, reuse)

• Track requests for information(Require patient consent)

• Opt in vs. Opt out

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Auditing & LoggingAuditing & Logging

• Keep track all accesses to network services– Intentional vs. unintentional– Connection vs. disconnection

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Criteria-based StandardsCriteria-based Standards

• To assure the interoperability and reuse of information from many sources

• Data communication protocols• Data content, format • Technical compatibility among systems

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Scope of Services ProvidedScope of Services Provided

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Knowledge of WorkflowKnowledge of Workflow

• Data processing procedure (When, Who, How)

• Patient data types (What, Whose)

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Portal for AccessPortal for Access

• Different portals for different types of information exchanges

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Health Information Exchange Health Information Exchange ModelsModels

• Government-led HIE: direct government program

• Public utility HIE: with government oversight

• Private sector-led HIE: government as a stakeholder for collaboration and advisement

• Public authority HIE : a government created nonprofit authority with powers to operate in a business-like manner

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Health Information Exchange Health Information Exchange Business ModelsBusiness Models

• Business models designed for financial sustainability:– Membership fee model– Transaction fee model– Program and service fee model

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Driving ForcesDriving Forces• Reduce data duplication and related costs• Reduce discrepancies among information

from may sources and related fixing costs• Provide a uniform holistic picture of the

patient’s health to improve care quality

• Underlying key success factor: Electronic Health Records (HER) and Electronic Medical Record (EMR) must be first broadly adopted/implemented

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Current ObstaclesCurrent Obstacles• Size and scope of the project• Time / Costs• Critical mass of data to be exchange• Collaboration between competitors

(providers)• Technical skills / necessary clinical

knowledge to use the system• Resistance to change• Composition and structure of governing

agency

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Future DirectionsFuture Directions

• Statewide HIE initiatives have started – HIE enabler/readiness (coordinating initiaties)– HIE outsourcing/technical partnership

(technology implementation and services)– HIE operator (implementation and

management)

• A national health information network to be build

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Some ReferencesSome References

• http://www.himss.org/files/himssorg/content/files/hie/hie_guidewhitepaper.pdf

• http://www.himss.org/files/HIMSSorg/content/files/RHIO/RHIO_HIE_GeneralPresentation.pdf

• http://www.health.state.mn.us/divs/hpsc/ohit/hieguidance/hieguide.pdf

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