Electronic health information exchange

Electronic health information exchange (HIE) is the electronic sharing of patient data between different health care organizations, allowing providers to see portions of a patient’s medical record (e.g., test results, immunization histories, imaging studies, etc.) outside the patient’s usual clinic. Systems must be interoperable, i.e., capable of ‘talking to each other,’ to support health information exchange. Electronic health records (EHRs) designed to exchange information with other EHRs, health information technology systems interfacing with EHRs, patient portals for physicians without EHRs, and regional health information organizations (RHIO) that pool data from different organizations in a centralized database are all examples of health information exchange. 

Expected Beneficial Outcomes (Rated)

  • Improved quality of care

Other Potential Beneficial Outcomes

  • Reduced hospital utilization

  • Increased adherence to clinical guidelines

  • Reduced unnecessary testing

Evidence of Effectiveness

There is some evidence that health information exchange (HIE) improves quality of care (Lammers 2014*, Bailey 2012, Kern 2012, Frisse 2011). Additional evidence is needed to confirm effects.

Accessing patient data through HIE in an emergency department appears to reduce hospital admissions (Frisse 2011), decrease diagnostic imaging (Lammers 2014*, Bailey 2012) and procedures (Winden 2014*), and increase adherence to evidence-based guidelines (Bailey 2012). In ambulatory care settings, use of a patient portal to access patient clinical data may improve quality of care (Kern 2012). Overall, HIE appears to increase provider access to data necessary for treatment such as results of tests conducted in another health care practice (Fontaine 2010), while lack of exchange may result in duplicate and unnecessary testing (Stewart 2010).

Lack of interoperability between health information technologies (HIT) is an often cited barrier to implementing electronic health records (EHRs) (AHRQ-JASON 2014, Marchibroda 2014*, McGinn 2011) and effective clinical decision support systems (AHRQ-Sachs 2011). Systems that are not interoperable may negatively affect workflow and productivity, which can contribute to physician resistance to EHR adoption (Castillo 2010). Some experts suggest designating an entity to establish standards for interoperability in the US (CWF-Gray 2011), others propose a federal mandate supporting technical interoperability and regulation of related processes and standards (Sao 2013*).

A Memphis-based study of HIE use in emergency departments indicates net annual cost savings, even after accounting for costs related to HIE (Frisse 2011); additional study is needed to confirm savings in ambulatory care (Fontaine 2010).

Impact on Disparities

No impact on disparities likely

Implementation Examples

From 2008 to 2012, hospital health information exchange (HIE) increased across provider types, organizational affiliations, and type of clinical information (Furukawa 2013*). As of 2009, almost 11% of US hospitals were engaging in HIE with unaffiliated providers, and health information organizations existed in slightly more than half of all healthcare markets (Adler-Milstein 2011). By 2012, nearly 6 in 10 hospitals actively exchanged health information, particularly lab results or radiology reports (Furukawa 2013*), and 30% of hospitals and 10% of ambulatory care practices participated in one of the 110 operational Health Information Exchanges in the US (Adler-Milstein 2013*).

The federal Office of the National Coordinator (ONC) for Health Information Technology recently released a 10-year vision to achieve an interoperable health IT infrastructure. This infrastructure includes establishing core technical standards and functions, certifying interoperable products and services, protecting privacy and security, creating supportive business, clinical, cultural and regulatory environments, and establishing rules of engagement and governance (ONCHIT 2014).

Implementation Resources

AHRQ-HIE evaluation toolkit - Cusack CM. Hook JM, McGowan J, Poon E, Zafar A. Evaluation toolkit: Health information exchange projects 2009 update. Rockville: Agency for Healthcare Research and Quality (AHRQ). 2010.

AHRQ-HIE privacy and security toolkit - Dimitropoulos LL. Privacy and security solutions for interoperable health information exchange: Privacy and security assessment of variation toolkit. Rockville: Agency for Healthcare Research and Quality (AHRQ); 2007.

AHRQ-JASON 2014 - JASON: The MITRE Corporation. A robust health data infrastructure. Rockville: Agency for Healthcare Research and Quality (AHRQ); 2014.

Torres 2014-Beacon Communities - Torres G, Swietek K, Singer R. Building and strengthening infrastructure for data exchange: Lessons from the Beacon communities. eGems (Generating Evidence & Methods to improve patient outcome). 2014;2(3):1-9.

Citations - Evidence

* Journal subscription may be required for access.

Lammers 2014* - Lammers EJ, Adler-Milstein J, Kocher KE. Does health information exchange reduce redundant imaging: Evidence from emergency departments. 2014;52(3):227-234.

Bailey 2012 - Bailey JE, Wan JY, Mabry LM, et al. Does health information exchange reduce unnecessary neuroimaging and improve quality of headache care in the emergency department? Journal of General Internal Medicine. 2013;28(2):176-83.

Kern 2012 - Kern LM, Barrón Y, Dhopeshwarkar R V, Kaushal R. Health information exchange and ambulatory quality of care. Applied Clinical Informatics. 2012;3(2):197-209.

Frisse 2011 - Frisse ME, Johnson KB, Nian H, et al. The financial impact of health information exchange on emergency department care. Journal of the American Medical Informatics Association (JAMIA). 2011;19(3):328-33.

Winden 2014* - Winden TJ, Boland LL, Frey NG, Satterlee PA, Hokanson JS. Care everywhere, a point-to-point HIE tool: Utilization and impact on patient care in the ED. Applied Clinical Informatics. 2014;5(2):388-;401.

Fontaine 2010 - Fontaine P, Ross SE, Zink T, Schilling LM. Systematic review of health information exchange in primary care practices. Journal of the American Board of Family Medicine (JABFM). 2010;23(5):655-70.

Stewart 2010 - Stewart BA, Fernandes S, Rodriguez-Huertas E, Landzberg M. A preliminary look at duplicate testing associated with lack of electronic health record interoperability for transferred patients. Journal of the American Medical Informatics Association (JAMIA). 2010;17(3):341-44.

AHRQ-JASON 2014 - JASON: The MITRE Corporation. A robust health data infrastructure. Rockville: Agency for Healthcare Research and Quality (AHRQ); 2014.

Marchibroda 2014* - Marchibroda, J. Health policy brief: Interoperability. Health Affairs; August 11, 2014.

McGinn 2011 - McGinn CA, Grenier S, Duplantie J, et al. Comparison of user groups' perspectives of barriers and facilitators to implementing electronic health records: A systematic review. BMC Medicine. 2011;9(46):1-10.

AHRQ-Sachs 2011 - Sachs J, Yonek JC, Mullins CD, et al. Impact of health IT on lab order use in community health centers. Rockville: Agency for Healthcare Research and Quality (AHRQ), US Department of Health and Human Services; 2011.

Castillo 2010 - Castillo VH, Martínez-García AI, Pulido JRG. A knowledge-based taxonomy of critical factors for adopting electronic health record systems by physicians: a systematic literature review. BMC Medical Informatics and Decision Making. 2010;10(60):1-17.

CWF-Gray 2011 - Gray BH, Bowden T, Johansen I, Koch S. (2011). Electronic health records: An international perspective on 'meaningful use.' The Commonwealth Fund. 2011;28:1-18.

Sao 2013* - Sao D, Gupta A, Gantz DA. Interoperable electronic health care record: A case for adoption of a national standard to stem the ongoing health care crisis. The Journal of Legal Medicine. 2013;34(1):55-90.

Citations - Implementation Examples

* Journal subscription may be required for access.

Furukawa 2013* - Furukawa MF, Patel V, Charles D, Swain M, Mostashari F. Hospital electronic health information exchange grew substantially in 2008-12. Health Affairs. 2013;32(8):1346-54.

Adler-Milstein 2011 - Adler-Milstein J, Desroches CM, Jha AK. Health information exchange among US hospitals. The American Journal Of Managed Care. 2011;17(11):761-768.

Adler-Milstein 2013* - Adler-Milstein J, Bates DW, Jha AK. (2013). Operational health information exchanges show substantial growth, but long-term funding remains a concern. Health Affairs. 2013;32(8):1486-1492.

ONCHIT 2014 - The Office of the National Coordinator for Health Information Technology (ONCHIT). Connecting health and care for the nation: A 10-year vision to achieve an interoperable health IT infrastructure; 2014.

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