Health Information Exchange - Research Paper Example

Health Information Exchange In the recent past, the Department of Health and Human Services has been committed to transforming the delivery of healthcare into a system that is value-based and patient-centered. Existing Medical and Medicare programs, initiatives as well as new programs that Patient Protection and Affordable Care Act authorize focus on new payment models and service delivery that facilitate and encourage greater coordination of healthcare delivery and enhanced quality. Crucial to successes of these programs and realization of the final goal of transformed healthcare systems is the real time interoperable Health Information Exchange. There is need to instant communication between all healthcare stakeholders; laboratories, hospitals, physicians, health planners and players as well as patients. Vast and ready access to patient-level health information is crucial for the improvement of efficiency, quality and safety of healthcare delivery. Health Information Exchanges enable the secure use and exchange of electronic health information. This is often tremendous to the improvement of healthcare quality, reduces the costs of paving way for increased interoperability and sharing of information between patients, payers, providers and other stakeholders as well as reducing medical errors. State-based and other regional Health Information Exchanges already in existence provide imperative user benefits such as secure data exchange and timely communication (FutureTech 2012). There is also regional collaboration and elimination of duplicate and inefficient services. Additionally, Health Information Exchanges play an important role in the building of the Proposed National Health Information Network which promotes interconnectivity among users of various stages in the healthcare information provision. Health Information Exchanges are taking root within the country despite governance, technical, funding and institutional challenges. Presently, there are over 150 Health Information Exchanges projects in various stages of development and maturity that employ a variety of types of business models (Shukla et. al., 2011). The key to realizing the sustainability of these projects is defining workable business models and working in close association with stakeholders and addressing the unique needs of the organizations to realize flexibility necessary for accommodating evolution and needs. Types of Health Information Exchanges a) Federated Federated Health Information Exchange refers to a collection of data repositories that are located remotely. A centralized HIE agrees to provide an overreaching central or state authority with a unique patient identifier information that is stored in the state-wide Health Information Exchanges registry. As opposed to Centralized HIE, Federated HIE does not store patient data in a centralized, accessible location. Storage of patient information continues to be stored regionally with Regional Central Authority. Fig 1: Federated HIE i) Regional Central Authority The Regional Central Authority is the body responsible for storing patient information in a federated HIE system. Several Regional Central Authorities are directly answerable to the State Central Authority. Hospitals in a particular region get information pertaining to patients from the Regional Central Authority. ii) The Record Locator Service (RLS) holds information that is authorized by the patient about the places where the patient’s information can be found. This does not include the actual information that the records contain. It allows for separation for the purposes of privacy and security as well as preservation of autonomy of the participating parties. Under RSL, the release of information from one party to another must be authorized. In certain situations, the providers or the patients may choose not to share some information. Fig 2: RSL Model (Braunstein 2012) iii) Send Query Messages to HIE In order to retrieve data belonging to a particular patient, member organizations send query messages to the Regional Central Authority registry. The patient registry at Regional Central Authority contains virtual roadmaps indicating the locations of patients’ records. This is searchable by a combination of unique patient identifiers. Such unique combinations of identifiers contain social security number and name among others. Whenever a patient’s records are identified in the registry, State Central Authority transmits the information of the physical location back to the organization that requested for the records. The requesting organization then requests for information pertaining to the patient to the patient from the facility that stores the patient’s records. The facility that holds the required information can thereafter send the records via secure web services, secure email or through VPN connection. Problems Associated with Federated HIEs Despite providing a reliable means of getting information from one facility to another, the architecture has a number of flaws. These include the following: 1. Less Interoperable Federated system does not allow for a simple exchange of information between hospitals and health centers in the Electronic Health Records system. Unlike the centralized system, federated system is less interoperable. The architecture does not allow for the necessity to ensure authorized and legitimate access to all the third party systems that are connected in the map. 2. Difficulty of Keeping Track of Duplicate Health Records Further, federated architecture lacks the capacity to track the numerous duplicate entries of patient information that could only act to clog the system. There are possibilities that records of a single patient could be replicated in different health facilities, taking unnecessary space and adding to uncalled-for complexity of the system. It, therefore, does not make sense to have a system that does not simplify the extent of information stored. Redundant records are never noticeable in this architecture, making the system inefficient and unnecessarily bulky. 3. Complexity of Locating a Patient’s Complete Medical Records Additionally, there is always the complexity of locating the full records of a patient. Since the records are never centralized, different health facilities have portions and bits of information concerning patients. It becomes hard to gather all the information that an organization needs about a patient. Information gathered is often shaky. It takes a lot of effort and time to get comprehensive information about a single patient in the federated HIE architecture. Centralized HIE Model Clinical Data Repository Centralized HIEs have Single Clinical Data Repository. The CDR is maintained by HIE authority that is usually governed by representatives from all member hospitals. Centralized architecture can be used at regional basis. For instance, hospitals located within the same metropolis may opt to use a centralized HIE architecture. i) Clinical Data Repository (CDR) Each of the member hospitals transmit health information about patients to the CDR. The information is securely stored in the CDR and undergoes incessant updates via interfaces that are usually connected to the data repositories of individual member hospitals. The interfaces could as well be directly connected to the Health Information Systems of the hospitals. ii) Data Exchange Data pertaining to patients flow to the central authority via the interfaces. At the same time, relevant records undergo updating. The same interface gets the data back to the member hospitals whenever it is requested. This counter flow of data takes place upon admission of a parent by entering pre-defined unique identifiers that may include the patient’s name and social security number. a) HL7 Interface HL7 is an abbreviation of Health Level Seven which defines the standards for exchanging information between various medical applications. The standard defines the format for transmission of health-related information. Data transmitted in the HL7 standard is sent as an assortment of one or more messages, each transmitting one item or record of health related information. Examples of messages under the HL7 include billing information and laboratory records. b) Continuity of Care Document (CCD) This specification is an XML based markup standard that intends to specify the structure, semantics and coding of patient summary clinical records for exchange. It is a constraint in the HL7 standard. It specifies that content of records consists of mandatory textual part and optional structural part. The textual part ensures human interpretation of the record contents while the structural part ensures software processing. Structured portion of the specifications is based on the Health Level Seven Reference Information model and details the scheme for referring to the concepts from coding schemes such as LOINC and SNOMED. Blended HIE In blended HIE, some information is stored centrally as other records are accessed by sending queries to participant organizations. Practically, all HIEs subscribe to the blended architecture of some sort. While Federated architectures have more features of federated architecture while centralized systems portray more characteristics of centralization, both contain traits of the other. Information systems that fall in between Centralized and Federated are referred to as Blended (Wong 2008). Nationwide Health Information Network NwHIN refers to a set of standards, policies and standards that enable for secure exchange of health information over the Worldwide Web. Nationwide Health Information Network does not refer to a physical network that runs on the servers of United States Department of Health and Human Services. Either way, it does not refer to a vast network which stores records of patients. The services, policies and services have helped move health provision services from paper-based medical records carried from one office of the doctor to another to a process that stores information securely and electronically. Pilots of Federated HIE i) New York The New York Exemplar HIE Governance Entities include three scopes. The first details a number of activities that will have regular reports done on monthly basis as well as requirements for ONC reporting. Second scope focuses on the participation and collaboration of NYeC with ONC Governance Forum. The third scope focuses on patient matching. ii) California A HIE pilot program in California intends to determine the consensus, practices and policies that create trust among HIOs. It also labors to establish and utilize lightweight infrastructure that exchange health information. It has direct specifications for directed exchange among individual providers and exchange specifications for response or query between organizations. iii) Colorado CORHIO is the designated entity for information exchange of health records for Colorado State. By April 2013, Colorado State had 28 hospitals and more than 700 doctors in the network (Payne 2008). iv) Maryland There has been a tremendous increase of 25% in IT adoption in Maryland hospitals since 1998. Maryland hospitals adoption in IT involves the following technologies, computerized physician order entry (CPOE), Electronic prescription and diagnosis, electronic medication and administration of records, Barcode medication and administration (BCMA), infection surveillance software (ISS), Telemedicine and Statewide Health Information Exchange. Many hospitals have adopted these technologies though others have not been able to adopt the technologies. v) Massachusetts Improved patient safety and quality of care, health information exchange and promotion of use of information technology through community based implementation of electronic health records are the main reasons the Massachusetts e-Health Collaborative (MAeHC) was formed. This has created a service of more than 500000 patients and incorporated more than 500 physicians. Shortage of capital, concerns of privacy and confidentiality and lack of technical skills are among the great challenges that have been identified in hampering successful implementation of Health Information technology in this part. vi) New Jersey Motivated by their long term goal of ensuring that all health providers in the state can easily access healthcare information technology regardless of the location, financial capacity or size of the Medicare, the New Jersey state has continued to be an active innovator of HIE. Under the American Recovery and Reinvestment Act of 2009, (ARRA), the New Jersey state applied for a HIE grant and were awarded the funding which they used for establishing three community HIEs and health-e-NJHIN. These when joined formed the wider State Wide New Jersey Health Information Network. New Jersey has also taken other steps such as the establishment of a HIE technical workgroup which evaluates and prioritizes use cases and puts into place operating procedures that are used in sharing health information. This include the secure use of; care summaries that is inclusive of continuity of care records and discharge summaries, medication database, medication history, radiology reports and medication allergies. vii) Oregon The Oregon Health Network has started building a statewide broadband Tele-health network. OHN has the goals of enhancing patient’s experience of care that is reliable, quality and accessible. Reduce or control per capita costs and improve the general health of the population. To promote health IT infrastructure in the state and in the facilities by health administrators, providers and executives, best practices are required. These practices include; collaboration, strategy and vision, implementation, connectivity, support and good flow of information, education, measurement, recruitment and retention, credentialing and privileging, policy and reimbursement. ii. How many organizations are currently paying to be part of the NHIN? There are a number of participants in the NHIN. They include: Consumer organizations which operate Personal health records Car delivery organizations which use electronic health records HIEs (health information exchanges) they are entities that help in the movement of data related to health within the region. Specialized participants: these are organizations with specific tasks in public health, promotion of quality health care or health research. What is the exact functionality a user gets when they are logged into the NHIN? A user of NHIN gets many functions from it. A user who is integrated into the system his/ physicians from far can share her information. The medical history of the patient can be saved in the database and accessed wherever need arises and this will help him to receive better services wherever the patient is. It also will help in situations where the patient cannot be able to give a description of his medical history and therefore access from the same database will help in the continuation of the treatment of the patient without contradiction of his medication history. In addition, medical research institutions logged into NHIN are able to conduct viable research on the main ailments that occur in a place. This helps to identify which cause of action is to be taken to prevent further illnesses. It also provides a trend of seasonal diseases and the importance of preparation beforehand. Researchers are also able to identify which treatment works best on the different grounds and this makes appropriate prevention and treatment of the people. Another functional aspect is to the physicians logged into NHIN. The physicians are able to keep up to date with the current trends in the prevention and treatment of diseases. They are able to know what types of medication have been effective in the cure of certain ailments and which have not been able to. This will help them in updating what they have and be in control of treatment. To the government logged in the system it helps to plan and invest in healthcare appropriately. This is by identifying regions that need more concentration in the health sector, regions that are best served in the health sector and where health services are not well distributed. It is also able to allocate budget provisions that are adequate in employing medical healthcare workers and establishing Medicare care centers. iv. Find out EXACTLY what data is transmitted between non-federated states. The HIE authority maintains a Clinical Data Respiratory in non-federated data. They have representatives in each member hospitals that utilize the centralized model of transmitting information in the same metro area. The hospital transmits patients’ health record electronically where they are stored and updated through interfaces that are connected to all member hospitals patients data respiratory. Patients’ data then flows to the central authority and updates all records, which are then sent to each member hospital when the patients data is requested. This model is expensive to install and requires a lot of resources and funding costs. Benefits of being part of an HIE Meaningful Use Stage 2 Reporting. This will ensure that all data of a patient is available according to 20 out of the 22 measures issued by Medicare and Medicaid services. These measures include; computerized provider order entry, generate and transmit permissible prescriptions electronically, record patients demographics, record vital signs and chart changes, record smoking status among others Providers who are members of an ACO (Accountable Care Organization) can earn more rewards from Medicare. Increased Productivity: Implementation of HIE can go a long way to increase productivity. HIE increase productivity by reducing billing errors, it reduces probability of lost or misplaced health records, it also enhances information efficiency as it is faster to communicate and administration of health centers is easy. Avoidance of Duplicate records: Use of the HIE will transfer all information to one database that would be used anywhere in the world. This will be like using one book to record medical history of one person. This therefore eliminates any other recording of information that could be biased and procedural and updated information about medical history will be obtained from one place. 5. HIE Sustainability For HIE to be sustainable a number of things should be done to ensure this. This will include: Understanding the revenue sources: They should understand the source of funding and if it will be sustainable to last it to the end of time. In addition, the revenue sources must be able to sustain research and improvement as the era of technological advancement will require so. For HIE to be sustainable it must be kept simple. This means that it should focus on few aspects to provide the biggest impact. For example, it should focus on improvement of healthcare and this will enable it to function more efficiently compared to when it is loaded with a number of functions to perform at a go. Another step is to align itself with ACO. When HIE understands what ACO requires, it can make good decisions on what functionalities it should include. HIE should also Endeavour to ensure patients privacy and confidentiality. This will go a long way to win the trust of the public and they will not shy away from using the facilities of HIE. a. Obstacles The main obstacles of HIE is maintaining privacy and confidentiality of patients information. In the light of cyber crime, it requires constant securing of its data and this is costly. Isolation of health information systems to health related areas such as hospitals and laboratories pose another challenge. This means that for the information to be retrieved one must be near a health institution. These posses challenges to mobile healthcares such as mobile clinics. A sustainable source of funding has not been reached yet. Most funding has come from the government. This means that for HIE to be a sustainable venture it must be able to source its own funding. References Payne, T. H. (2008). Practical guide to clinical computing systems: Design, operations, and infrastructure. Amsterdam: Elsevier/Academic Press. Wong, S. T. C. (2008). Medical image databases. Boston [u.a.: Kluwer Academic Publ. Shukla, A., Tiwari, R., & IGI Global. (2011). Biomedical engineering and information systems: Technologies, tools and applications. Hershey, PA: Medical Information Science Reference. Braunstein, M. L. (2012). Health informatics in the cloud. New York: Springer Verlag. FutureTech (Conference), & Park, J. J. (2012). Future information technology, application, and service: FutureTech 2012. Dordrecht: Springer. Read More