Depending upon the types of information shared, these message and query processes can be combined in an enormous number of ways to meet a wide range of needs, including but not limited to:
- delivering a diagnostic test result or case report
- delivering immunization data to an immunization information system
- reviewing records for outbreak investigations
- performing population health surveillance
- alerting providers of opportunities to improve a patient's care (often called clinical decision support)
HIE typically refers to information exchange between healthcare providers, but patients' ability to View, Download and Transmit (VDT) their own records using Blue Button standards (and supported in Meaningful Use regulations) offers a new twist. Patient-mediated exchange may provide an alternate pathway for HIE, and because the exchange is patient-driven, it can obviate some of the privacy and confidentiality concerns of inter-provider exchange.
The simplest "push" messaging HIE process does not require a sophisticated HIO. Two professionals could send each other health information using relatively simple secure messaging protocols, such as DIRECT encrypted email, if they know one another's secure email addresses and can exchange the necessary decryption keys.
However, because of the large number of entities that seek to communicate from time to time (e.g., doctors, hospitals, pharmacies, labs and now even patients), it rapidly becomes impractical for each to establish one-on-one communications with all possible exchange partners. Nor does such simple messaging allow for more sophisticated exchange, such as "pulling" and integrating information about one patient from multiple providers simultaneously. This is where the Health Information Exchange Organization (HIO) may come in to provide these more complex exchange services.