Deciding to Engage

Why Bother? Why Partner? Why Now?

While the concept is not new, electronic HIE has become an increasingly urgent topic for public health. Telephone, mail and fax were adequate - if slow, error-prone and labor-intensive - for exchanging health information when medical records, physician orders, diagnostic results, prescriptions and bills were managed on paper. However, the rapid adoption of electronic medical records (EMR) and other clinical information systems is increasing the need for sending and receiving information electronically.

HIE is just one element of transforming healthcare through better information practices, working in combination with the use of comprehensive and longitudinal electronic health records (EHR), as well as appropriate incentives and policies.

The following sections offer information on some of the key environmental factors behind HIE's increasing prevalence.

HIE in the Transformation of Healthcare

Figure 2. HIE in the Transformation of Healthcare
Source: Blumenthal D. Launching HITECH. N Engl J Med 2010; 362:382-385. http://www.nejm.org/doi/full/10.1056/NEJMp0912825

Federal Incentives: HITECH and Meaningful Use

HIE adoption was accelerated by the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act and its Electronic Health Record (EHR) Incentive Program, often called the "Meaningful Use" program, operated by the U.S. Centers for Medicare and Medicaid Services (CMS) in collaboration with the Office of the National Coordinator for Health Information Technology (ONC).

These laws and regulations provide financial incentives for clinicians and hospitals to adopt electronic medical record (EMR) systems, and require them to exchange information electronically with each other and with pharmacies, labs, public health departments and others serving the same patient. They also support various parts of the infrastructure for HIE at the national and statewide levels.

The EHR Incentive Program contains Meaningful Use incentives and new certification specifications for information exchange between EHR systems and public health programs. As of Stage 2 of Meaningful Use, these include:

Electronic laboratory reporting (ELR) of communicable diseases by hospitals
Reporting vaccinations to immunization information systems (sometimes called immunization registries)
Reporting hospital and doctor visits to syndromic surveillance systems
Supplying data to cancer and other registries

Clinics and hospitals are now seeking to establish HIE with health departments to earn Meaningful Use Medicare & Medicaid incentive payments, as well as to eliminate costlier and slower methods of exchanging information.

Thus, the new standards for healthcare providers are becoming de facto standards for public health information systems as well. Many health departments will need to adopt such standardized HIE, or face the equivalent of using telegraphs after others have switched to telephones.

Federal Incentives: The Affordable Care Act

The more recent Patient Protection and Affordable Care Act (ACA) does not often mention HIE, but it creates incentives and structures for quality-, safety- and population-based care initiatives (like Accountable Care Organizations [ACO]) that effectively require information exchange.

In addition to sending and receiving individual messages, information exchange can be used to assemble information about each patient from multiple EMRs to create a comprehensive lifetime record. Such an EMR can be used to improve the quality, efficiency and safety of both individual healthcare and population health.

These capabilities are foundational to health reforms associated with the ACA. Sooner rather than later, these capabilities will change how public health is practiced.

Conceptual Model of HIE

Figure 3. Conceptual Model of HIE
Source: HIMSS/MGMA. Overview: Knowing the HIE Basics. Jan. 20, 2011. http://www.himss.org/files/HIMSSorg/Content/files/AmbulatoryHIEToolkit-OverviewKnowingtheHIEBasics.pdf

State and Community Efforts

Many local and state health departments have led HIE development in their own communities. For example:

Public health leadership has often been critical to facilitating collaboration among competing healthcare providers.
The immunization registry was an early, single-function model of HIE.
Some health departments participated in HIE development to promote near-real-time case reporting of reportable diseases. Some also used HIE to monitor surges in healthcare utilization to detect or track outbreaks - this is now referred to as syndromic surveillance.
Others have used information exchange to establish disease registries and improve chronic disease management.

Now that federal programs are incentivizing exchange and establishing national specifications, health departments may be less prominent in driving exchange, but may see more benefits faster.

Communities are beginning to use HIE to support more profound health system transformation, for instance:

to support better care coordination and access;
to measure, analyze and improve the delivery of clinical preventive services for individuals, or for entire populations
to aggregate HIE data to map and attack health inequities

HIE is not a destination - it is a foundation.

HIE is both catalyst and mechanism for ongoing improvement in public health surveillance, healthcare and preventive services. Not every health department needs to implement HIE today. Some local health departments, for instance, may find it more appropriate to rely on state-operated information systems to exchange information with healthcare providers.

The next section of this toolkit, Do We Need HIE Today?, offers tools to assist public health departments in determining when to make HIE a priority.

Nevertheless, every health department will be affected as HIE changes the characteristics, speed and volume of data exchange activities with healthcare providers. It is critical to be prepared to use this information for the benefit of the public's health.

Continue to Next Page: Does My Health Department Need HIE Today?

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Introduction