Quick Reference Guide
PANHANDLE HEALTH INFORMATION EXCHANGE
TABLE OF CONTENTS
INTRODUCTION..................................................................................................... 3
GLOSSARY.............................................................................................................. 5
Annual Support and Maintenance
Computerized Provider Order Entry (CPOE)
Information
Silos or Stovepipes
National Health Information Network
Office
of the National Coordinator for
Health Information Technology (ONC)
Work breakdown structure (WBS)
EXPLORATION OF SELECTED
TERMS
Agency
for Healthcare Research Quality........................................................ 11
Architecture.................................................................................................... 12
Health Information
Exchange......................................................................... 20
Patient Matching Across
Partnering Institutions.............................................. 26
Protected/Sensitive
Information...................................................................... 28
Standards........................................................................................................ 29
Stark and Anti-Trust....................................................................................... 31
Use Case Matrix............................................................................................. 33
FREQENTLY ASKED QUESTIONS....................................................................... 35
Do we all need to use the same EMR product?
Would it be better if we all used the same EMR product?
EXAMPLES OF RHIOS WITHIN
THE DOCUMENT
HealthBridge................................................................................................... 16
Inland Northwest
Health Services................................................................... 15
Indianapolis
Network for Patient Care............................................................ 17
MAShare (Simplifying Healthcare Among Regional Entities)......................... 17
Mendocino SHARE........................................................................................ 17
Santa
Barbara County Care Data
Exchange.................................................... 19
Use Matrix................................................................................................ 33
Utah Health
Information Network.................................................................. 33
REFERENCES.......................................................................................................... 36
Health information sharing has been identified as the key goal for the providers involved in the Panhandle Health Information Exchange project. The partners’ vision is a system that:
- Collects data from multiple sources
- Is used by providers as the primary source of information at the point of care or service
- Provides evidence-based decision support
- Is viable and sustainable
- Operates within the established networks of rural hospitals, clinics, public health providers, behavioral health providers, and others
The partners envision a regional electronic health information exchange system that will enable providers, patients, and others to share information, communicate orders and results, support evidence-based decision-making, streamline public health disease surveillance and reporting, and enable data management for non-clinical purposes (e.g., billing, quality management). Information will be patient-centric (i.e., available where the patient and his/her provider needs it regardless of where the information was originally gathered). Transmission and access of information by authorized individuals will be through secure systems. Technologies and connectivity options will continue to evolve. The partners intend to create a technology that will enable all organizations with basic technological infrastructures to participate.
IMPLEMENTATION PROCESS
Beginning October 2005, the partnering organizations began moving toward implementation of health information exchange. This project will continue to contribute substantially to achieving an improved, sustainable system of collaborative healthcare that respects the autonomy of hospitals and creates a compatible, shared, unified paperless system that has the capability to seamlessly share patient information among hospitals and providers in real time, which will tie into national standards for integration into national networks.
The partners' vision for shared electronic health information has a long-term goal of connecting all health and human services providers and ancillary services in the Panhandle, as well as those that connect to others in the multi-state area, to share patient information and provide a high-quality system of care for rural residents.
The goal of this regional partnership of hospitals, behavioral health providers, public health, and health and human services providers is to improve quality of care and patient safety by:
- Enabling the exchange of health information between providers;
- Contributing to the viability of partners by identifying and promoting collaborative wins;
- Ensuring that all hospitals and providers have the capacity to participate in electronic exchange;
- Continuing to promote the vision of a system of care for Panhandle residents;
- Building capacity within the workforce.
The intermediate goal is health information interoperability between hospitals, clinics, private physicians' offices, pharmacies, and behavioral health providers.
The short-term goals are to establish:
- Electronic medical records that will integrate with other functional systems (decision support systems, CPOE/e-Prescribing, results management, laboratory) in all Critical Access Hospitals and Rural Health Clinics through a common process and shared resources, in order to enhance local and regional capacity development toward health information exchange.
- A health information exchange system that will provide current information, from all hospitals and rural health clinics, at the point of care.
- An operational entity and incorporated RHIO that will provide the sustainable infrastructure necessary to support regional health information exchange and common developments in the Electronic Health Records.
PLANNING PROCESS
The implementation process is proceeding, based on the yearlong work undertaken from October 2004-September 2005. In September 2005, the partners issued The Panhandle Regional Health Information Exchange Plan. The Plan describes how the partners plan to move forward and also describes the planning process. The Plan may be of particular interest to small hospitals across the nation because it describes the wide variability in technological capacity and readiness represented by the partnering organizations. The Plan focuses on:
- Delineating a standards-based, coherent, scalable and achievable technology solution
- Articulating the value proposition for individual organizational partners, the critical access network and the regional community
- Including all hospitals within a regional critical access health network and extend to all health clinic and behavioral health providers
- Including participation from all levels of leadership from participating partners
- Working within existing collaborative and information channels to ensure scalability and extensibility to other key health care providers, such as bioterrorism, public health and other safety net providers
AHRQ - Agency for Healthcare Research Quality, a part of the U.S. Department of Health and Human Services.
Annual Support and Maintenance - Costs that are typically 15-20% of the software license
costs. Where the actual license is normally a one- time fee, the support and
maintenance costs are renewed on a yearly basis. This yearly fee basically
covers two areas: 1) any upgrades or new releases; and 2) customer service and
support. It should be noted that both vendor EHR software and third party
software will need support, so it is important to determine which components
the support costs cover. Also, some vendors might have more than one service
level agreement representing different support options at different costs.
Application Service Provider (ASP) - an ASP is a company that creates health (and in many other arenas, as well) information technology solutions available on a subscription basis to health care entities and RHIOS. The ASP distributes the solution from its home central location to customers elsewhere. Thus, an ASP is responsible for maintaining, updating, and troubleshooting solutions (making sure it is available 24/7, ensuring redundancy, etc) that health care entities/RHIOs would otherwise be responsible for doing. ASPs can be an inexpensive way to manage information services.
Architecture - “a formal description of an IT system, organized in a way that supports reasoning about the structural properties of the system. It defines the components or building blocks that make up the overall information system, and provides a plan from which products can be procured and systems developed, that will work together to implement the overall system” (Tsiknakis et al., 2002, p. 9). There are three general architectural approaches being used in health information exchange:
Centralized architecture is “an approach to RHIO data sharing and inter-change of electronic information emphasizing full control over data sharing through a centralized repository. Components in a centralized architecture refer to the Central Data Repository (CDR) and the requestor. The CDR authenticates the requestor through a technological means, authorizes the transaction and records it for audit and reporting purposes” (HIMSS, n.d.).
Federated architecture (decentralized) is an approach to the coordinated sharing and interchange of electronic information emphasizing partial, controlled sharing among autonomous databases within a RHIO. In a federated architecture, independent databases (decentralized) are connected to share and exchange information. Components in a federated architecture represent the various users, applications, workstations, main frames and other stakeholder components in a RHIO. Each component controls its interactions with other components by means of an export schema and an import schema. The export schema specifies the information that a component will share with other components, while the import schema specifies the non-local information that a component wishes to manipulate. The federated architecture provides a means to share data and transactions using messaging services, combine information from several components and coordinate activities among autonomous components. (HIMSS, n.d.)
P2P (peer-to-peer): “a network structure in which the computers share processing and storage tasks as equivalent members of the network. Different from a client/server network, in which computers are assigned specific roles…A general term for popular file-sharing systems…in which there is no central repository of files. Instead, files can be stored on—and retrieved from—any user’s computer” (iHealthBeat, n.d.).
Audit trail – a chronological record of system activity which enables the reconstruction of information regarding the creation, distribution, modification, and deletion of data.
Authentication – a method to verify that the person or entity seeking access to information on a secured Health Information Exchange is the one claimed.
Authorization - the role or set of permissions for information system activity assigned to an individual.
Best of Breed: The organization buys the best product for a specific function, regardless of how the application interfaces with other applications and systems. This approach often requires expensive integration and support.
Best of Fit: Organization limits its selection to products that fit best with existing applications and systems.
Best of Suite: A combination of the “Best of Breed” and “Best of Fit.” The organization may use vendor product suites to reduce the number of interfaces needed between numerous systems.
Computerized Provider Order Entry (CPOE) - a computer application that allows a physician's orders for diagnostic and treatment services (such as medications, laboratory, and other tests) to be entered electronically instead of being recorded on order sheets or prescription pads. The computer compares the order against standards for dosing, checks for allergies or interactions with other medications, and warns the physician about potential problems (Office of the National Coordinator for Health Information Technology, n.d.).
Data Models - the technical term for the architecture of the data sharing system.
Data Ownership – the decisions around
who owns shared data and its implications for use.
Data Pipes - the actual networks over which data will flow from place to place
Data Repository – the database/s that hold patient data
Data-Sharing Agreements – executed, formalized documents that define the polices and procedures for data sharing
Electronic Health Record –
“a subset of each care delivery organization s EMR, presently assumed to be
summaries like ASTM s Continuity of Care Record (CCR) or HL7 s Continuity of
Care Document (CCD), is owned by the patient and has patient input and access
that spans episodes of care across multiple CDOs within a community, region, or
state (or in some countries, the entire country). The EHR in the
Electronic Medical Record – “an application environment composed of the clinical data repository, clinical decision support, controlled medical vocabulary, order entry, computerized provider order entry, pharmacy, and clinical documentation applications. This environment supports the patient s electronic medical record across inpatient and outpatient environments, and is used by healthcare practitioners to document, monitor, and manage health care delivery within a care delivery organization (CDO). The data in the EMR is the legal record of what happened to the patient during their encounter at the CDO and is owned by the CDO” (HIMSS Analytics, 2006, p. 1).
Electronic Prescribing (e-Prescribing) - provides features to enable secure bidirectional communication of information electronically between practitioners and pharmacies or between practitioner and intended recipient of pharmacy orders. HL7 (2004).
Global Patient Index (GPI) - a common medical record number or algorithm that identifies patients across several institutions
Health Information Exchange - HIE is “the sharing of clinical and administrative data across the boundaries of health care institutions and other health data repositories” (AHRQ, n.d.)
HL7 (http://www.hl7.org) – “an international community of healthcare subject matter experts and information scientists collaborating to create standards for the exchange, management and integration of electronic healthcare information. HL7 promotes the use of such standards within and among healthcare organizations to increase the effectiveness and efficiency of healthcare delivery for the benefit of all” (HL7, n.d.). It is the most widely used messaging standard and includes fields for: diagnostic results, notes, referrals, scheduling information, nursing notes, problems, and clinical trials data.
HIPAA - the Health Insurance Portability and Accountability Act of 1996. HIPAA’s Administrative Simplification provisions require the Department of Health and Human Services to establish national standards for electronic health care transactions and national identifiers for providers, health plans, and employers. It also addresses the security and privacy of health data.
Information Silos or Stovepipes - proprietary or other disconnected systems
that do not exchange information. This often results in multiple entry of
information or lack of access to information that others have.
Interface Engines - systems that interpret and transform information into structures and representations that make it usable
Interoperability - When two or more systems are able to talk to each other and share data
Migration Path - high level document tracking all of major projects that move the organization to its goal. The Path plots the journey toward Health Information Exchange and is complemented by, but distinguished from, Readiness Planning, Implementation, Adoption, Benefits realization.
National Health Information Network - The collective array of components that underlie nationwide interoperability, such as interconnection tools (mobile authentication, identification management, common web services architecture and security technologies); defined implementation regimens that are specified at the level of software code; common networking and communication tools to unify access and security; and mechanisms for ensuring the sustainable operation of these components on a widespread and publicly available basis must be defined. On November 10, 2005, HHS Secretary Mike Leavitt announced the award of contracts totaling $18.6 million to four groups of health care and health information technology organizations to develop prototypes for a Nationwide Health Information Network architecture.
neHII – Nebraska Health Information Initiative. This is an initiative that is exploring whether a statewide RHIO may be established. Partners include the Nebraska Hospital Association, the Nebraska Medical Association, Nebraska Pharmacists Association, Blue Cross/Blue Shield of Nebraska, and a variety of hospitals. Our Panhandle project sits around this table and is represented by Lisa Bewley, Dan Griess, Nancy Shank, Dr. Todd Sorenson, and Kim Woods.
Office of the National Coordinator for Health Information Technology (ONC, formerly referred to as ONCHIT) – (http://www.dhhs.gov/healthit/) provides leadership for the development and nationwide implementation of an interoperable health information technology infrastructure to improve the quality and efficiency of health care and the ability of consumers to manage their care and safety. The National Coordinator for Health Information Technology serves as the Secretary's principal advisor on the development, application, and use of health information technology; coordinates the Department of Health and Human Services' health information technology programs; ensures that health information technology policy and programs are coordinated with those of other relevant executive branch agencies; and to the extent permitted by law, develops, maintains, and directs the implementation of a strategic plan to guide the nationwide implementation of interoperable health information technology in both the public and private health care sectors that will reduce medical errors, improve quality, and produce greater value for health care expenditures, and coordinates outreach and consultation by the relevant executive branch agencies with the public and private sectors. The National Coordinator is David J. Brailer, MD, PhD.
Outbreak Surveillance - support clinical health state monitoring of aggregate patient data for use in identifying health risks from the environment and/or population (HL7, 2004).
PACS - Picture Archiving and Communication System for radiology images.
Partners in Panhandle Project - The
Regional Health Records for Nebraska's Panhandle project is the collaborative
work of the Rural Healthcare Cooperative Network (including Box Butte General
Hospital, Alliance; Chadron Community Hospital, Chadron; Garden County Health
Services, Oshkosh; Gordon Memorial Hospital, Gordon; Kimball Health Services,
Kimball; Memorial Health Center, Sidney; Morrill County Community Hospital,
Process Mapping - a technique for making work visible for improvement. It shows who is doing what, with whom, when and for how long. It shows decisions, sequence of events, and any waits times or delays in the process.
Record Locator Service - one
technical solution to finding the location of patient information
RHIO (Regional Health Information Organization) - is a “multi-stakeholder organization that enables the exchange and use of health information, in a secure manner, for the purpose of promoting the improvement of health quality, safety and efficiency. Officials from the U.S. Department of Health and Human Services see RHIOs as the building blocks for the national health information network (NHIN). When complete the NHIN will provide universal access to electronic health records. Experts maintain that RHIOs will help eliminate some administrative costs associated with paper-based patient records, provide quick access to automated test results and offer a consolidated view of a patient’s history” (HIMSS, n.d.).
Semantics - provide a way to code message components so their meaning can be interpreted or understood (e.g., which lab tests were performed and what their values are) when the message is deconstructed
Standards - the coding and messaging schemes used to share data. Standards apply both to syntax and semantics.
Syntax - provides the grammar rules for a defined "language" so that the electronic messages being exchanged can be properly deconstructed when received (AHRQ, n.d.)
Use Case Matrix – a matrix that identifies which users
will use information for what purpose.
Work breakdown structure (WBS) – a detailed listing of all tasks for each activity that needs to occur to accomplish a goal.
AGENCY
FOR HEALTHCARE RESEARCH AND QUALITY
(http://www.ahrq.gov/)
The Agency For Healthcare Research And Quality (AHRQ) is a part of the United States Department of Health and Human Services. AHRQ’s mission is to:
improve the quality, safety,
efficiency, and effectiveness of health care for all Americans. Information
from AHRQ's research helps people make more informed decisions and improve the
quality of health care services.
AHRQ awarded the Panhandle Regional Health Records project two grants to further our work:
- Transforming Healthcare Quality Through Health Information Technology Implementation Grant 1 UC1 HS016143-01, $1,498,623, (10/01/05-9/30/08)
- Transforming Healthcare Quality Through Health Information Technology Planning Grant 1 UC1 HS016143, $198,772, (10/01/04-9/30/05).
The AHRQ health information technology portion of the
website (http://healthit.ahrq.gov/portal/server.pt?open=512&objID=650&PageID=0&parentname=ObjMgr&parentid=106&mode=2&dummy=/index.html)
has lots and lots of information about health information exchange and about
other grantees across the
“Architecture” is defined as the “formal description of an IT system, organized in a way that supports reasoning about the structural properties of the system. It defines the components or building blocks that make up the overall information system, and provides a plan from which products can be procured and systems developed, that will work together to implement the overall system” (Tsiknakis et al., 2002, p. 9). A “health information exchange architecture” describes the framework for data sharing between healthcare data partners.
The architecture should reflect what information which stakeholders want to share. For example, Figure 1 provides an example of a information sharing architecture. This example comes from the Markle Foundation and helps to identify stakeholders and possible information flows between stakeholders, but it does not mandate the technical underpinnings of the system. That is, the information flows in Figure 1 could be implemented through myriad architectural designs.
Figure 1. Find, get, send information sharing model from the Markle Foundation (Markle Foundation, 2004, p. 77).
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The components of an HIE architecture include:
Network Connectivity - The low-level physical connections over which data will flow.
Messaging Standards - Specifications defining consistent message formats and response protocols that ensure accurate data exchange.
Vocabulary Standards – An agreed upon set of unifying codes that uniquely map the same concepts among separate systems into a single code.
Interface Engines - systems that can interpret and translate incoming messages
Record Locator Service - An emerging technology designed to aggregate patient data across large geographical distances or from multiple RHIO’s
Global Patient Index (GPI) – A mechanism for accurately managing patient identities among multiple data sources
Data Sources - the database/s that holds patient data
Our project will likely use existing T-1 lines that currently connect the hospitals. Where technically feasible, practical, and applicable we will leverage existing and emerging vocabulary standards, including LOINC® and SNOMED where applicable. Similarly, we will implement clinical messaging standards that are compatible with existing technology, and are flexible enough to accommodate future data sharing needs.
There are three general types of HIE architectures:
- Centralized
- Federated
- Peer-to-Peer
Most operational HIE’s are not pure representations of a single architecture. Rather, most exchanges blend components of multiple architectures, with one architecture dominating. Because most HIE’s implement a multiple architectures, it is helpful to understand the similarities and differences between the three types.
The distinguishing features of these three architectures are characterized by how and where Interface Engines, the Record Locator Service, the Global Patient Index, and the Data Repositories are used.
ISSUES TO CONSIDER
The architectural model should reflect the needs of the collaboration. Considerations include:
- Ability to maintain control and ownership of data at each entity
- Ability to implement its own security policies
- Ability to observe standards and create local protocols
- Concern about the security and patient privacy vulnerability in a centralized model
Centralized architecture is “an approach to RHIO data sharing and inter-change of electronic information emphasizing full control over data sharing through a centralized repository. Components in a centralized architecture refer to the Central Data Repository (CDR) and the requestor. The CDR authenticates the requestor through a technological means, authorizes the transaction and records it for audit and reporting purposes” (HIMSS, n.d.).
The key feature of a centralized system is that all shared patient data from all participating partners is maintained in a single, unified data repository.
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Interface Engines – either doesn’t exist (in the case where everyone is using the exact same system for electronic health records) or simultaneously interfaces between partners’ systems before transmitting information into the central data repository (and happens prior to any request for patient data).
The Record Locator Service and Global Patient Index (GPI) – are essentially the same function. The centralized data repository assigns a patient number that is used when information is matched to patients.
Data Repository – a centralized data repository contains all the information that is shared.
Examples of Centralized approaches:
Inland Northwest Health Services (www.inhs.org) – partnership of 34 hospitals with over 3000 beds in Washington, Idaho, Montana, Oregon, and Canada that participate in a centralized, integrated information system that shares a single client identifier.
Federated architecture (decentralized) is:
an approach to the coordinated sharing and interchange of electronic information emphasizing partial, controlled sharing among autonomous databases within a RHIO. In a federated architecture, independent databases (decentralized) are connected to share and exchange information. Components in a federated architecture represent the various users, applications, workstations, main frames and other stakeholder components in a RHIO. Each component controls its interactions with other components by means of an export schema and an import schema. The export schema specifies the information that a component will share with other components, while the import schema specifies the non-local information that a component wishes to manipulate. The federated architecture provides a means to share data and transactions using messaging services, combine information from several components and coordinate activities among autonomous components (HIMSS, n.d.).
Federated systems rely on a decentralized approach to record management, where information is only accessed when needed and clinical data is stored only in the site where created. A distinguishing feature of a federated system is that important technologies, like the Global Patient Index, are centralized, but each institution keeps its own Master Patient Index.
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Interface Engines – information is translated at the time of it being requested and is aggregated (from a single point that serves all entities) and sent to the inquirer.
Record Locator Service – a single Record Locator Service sits at the center of all partners. It uses a type of Global Patient Index (GPI) to match patients.
Data Repository – each partner holds its database of patient information.
Examples of Federated approaches:
HealthBridge (www.healthbridge.org) – provides clinical data exchange among 17 hospitals (in a 14-county tri-state area) and has created a community-wide message platform so physicians and their staff can use one electronic in-box to view radiology, lab, and transcription data, regardless of the organization it originated in. HealthBridge provides a variety of other products and solutions that users may participate in, including electronic chart completion, insurance eligibility checking, on-line referrals, outsourced faxing for physicians who do not wish to use electronic tools, outsourced community printing to share the cost of printing across all hospitals, hospital electronic medical records and administrative tools for hospital and physician offices throughout the Cincinnati area.
Indianapolis Network for Patient Care (http://www.inpc.org/) - is a regional computerized patient record system being developed by the Regenstrief Institute, Inc. through a contract with the National Library of Medicine. The INPC was created in 1994 as a a group of federated databases storing emergency room encounter records, hospital abstracts, clinical laboratory data, and other data as available for use by emergency department phycicians. Today it serves 17 hospitals and contains over 900 million discrete records for 2.5 million patients. Some have described the INPC architecture as centralized, but it is actually a federated design. Although all servers are housed and managed at Regenstrief (the partnering hospitals have chosen to use INPC to manage the data), the edge proxies could be housed at each of the partnering hospitals. The data for each institution is physically separate. So if a hospital decided it no longer wished to participate, they could be unplugged from the INPC with no loss of other systems data.
MAShare (Simplifying Healthcare Among
Regional Entities) (www.mahealthdata.org/ma-share/) – established in 2003, to
advance the introduction and deployment of clinical data exchange in
Mendocino SHARE
(www.ruralcommunityhealth.org/projects/msp.html) - is an alliance of 12 rural
partners implementing Health Records Exchange (HRE) using a secure Master
Patient Index and Record Locator Service to clinical data available through a
secure thin client to diabetes care providers to improve the quality of care
for our diabetic patient population. Eventually additional data sources,
functionality and user capabilities will be added. Mendocino SHARE's open
source solution is being built to developing open standards and the National
Health Information Network (NHIN) as described in the new Health IT Strategic Framework
from the Office of the National Coordinator for Health Information Technology
(ONCHIT). The capabilities underlying the SHARE solution will be available to
other communities beyond
P2P (peer-to-peer): “A network structure in which the computers share processing and storage tasks as equivalent members of the network. Different from a client/server network, in which computers are assigned specific roles” (iHealthBeat, n.d.).
Peer-to-peer is a system in which there is no central repository, instead, files are stored on—and retrieved from—any entities’ systems. The key feature of a peer-to-peer system is that all shared patient data is maintained by partners on their own systems. There is very little of an overarching infrastructure.
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Interface Engines – each entity has its own interface engine. The aggregation happens after the appropriate information sources are identified.
Record Locator Service – A type of RLS exists between all the peers to assist users to identify the patients and information they want to see aggregated.
Global Patient Index (GPI) – may or may not exist in a peer-to-peer system.
Data Repository – patient data is held by each partnering organization.
Examples of Peer-to-Peer approaches:
Santa
Barbara County Care Data Exchange (http://www.sbccde.org/)
– operates as a public utility and allows patient-specific clinical information
to be securely and readily accessible to any authorized person, including the
patient. It serves the
The partners have envisioned a system for health information exchange (HIE). A good definition of HIE is “the sharing of clinical and administrative data across the boundaries of health care institutions and other health data repositories” (AHRQ website, 2006).
There are lots of challenges to achieving HIE. Some important issues include:
· Technical - is it possible for the information to be shared (the connectivity, fidelity, and the message structure (the syntax of the information)? When systems are interoperable, it means that they are able to share electronic information in structures that are understandable to other systems.
· Semantic - does the information “make sense” and mean the same thing to the sender as the receiver?
· Social process - have the needed collaborative structures been created so that there is understanding and agreement? Do partners have consensus around issues of data ownership and use, and security practices? How do legal and regulatory issues privacy create barriers?
· Financial – the creation and maintenance of secure systems of exchange require investments that compete with other priorities within organizations, and the financial benefits (reduction in duplicative tests, etc.) often do not accrue to those making the investment.
There are many
kinds of Health Information Exchange “products.” That is, the kind of
information and how the information is used meet different needs. Samarth (2006,
pp. 8-17) has provided the following description of Health Information Exchange
types:
DIFFERENT
HIE TYPES TO CONSIDER:
1. Medication History
2. Web-based Disease Registry
3. Claims and Eligibility
4. Referrals Database
5. Results Repository (lab, rad, etc)
6. Encounter/Visit History
7. Patient Health Record
8. Reporting (Measures, Public Health, etc)
9. Connecting CHC Data
10. Integration with other RHIOs
Need to identify your HIE and then map to
feasibility.
1. Medication
History