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How Health Information Exchange and HIEs Support Healthcare’s Triple Aim

Health Gorilla's Guide to Healthcare Interoperability Resources (FHIR)

Health information exchange, as a concept, is the bidirectional routing of patient information, including electronic medical records, past procedures and/or surgeries, lab results, prescription profiles, and family history. It allows doctors, nurses, pharmacists, and other providers to access and share a patient's vital medical information electronically — impacting the speed, quality, safety, and cost of patient care.

Health Information Exchanges (HIEs) in practice are a central repository of data that is aggregated and normalized across multiple electronic health record (EHR) systems with the goal of providing a holistic view of the patient record in a secure, standardized format. 

Health information exchange as a concept and HIEs in practice are enhancing patient satisfaction and quality, improving the health of populations, and reducing the per capita cost of healthcare — the elusive Triple Aim everyone is working towards. Health information exchange and HIEs enable the timely sharing of data that informs better decisions and allows providers to avoid readmissions and medication errors, improve diagnostic accuracy, and decrease duplicate testing. 

According to HealthIT.gov, the official website of the Office of the National Coordinator for Health Information Technology (ONC), different forms of health information exchange serve different purposes:

Directed Exchange‍
Used by providers to send patient information easily and securely — such as laboratory orders and results, patient referrals, or discharge summaries — directly to another provider. This information is encrypted and shared between affiliated healthcare professionals and enables coordinated care, benefitting both providers and patients.

For example, primary care physicians referring patients to specialists can send electronic care summaries that include medications and lab results directly to the specialist. This information prevents redundant patient information collection, wasted visits, duplication of tests, and medication errors. 

Directed exchange is also used for sending immunization data to public health organizations or to report quality measures to the Centers for Medicare & Medicaid Services (CMS).

Query-Based Exchange
Used by providers to search and discover accessible clinical sources on a patient, particularly when a visit is unplanned or in a different location.

For example, emergency room physicians utilize query-based exchanges to access patient information, including medical history, chronic conditions, medications, and recent radiology images or lab results. This information will inform treatment decisions and prevent adverse medication reactions or duplicative testing. 

Another example might be when a pregnant woman goes to the hospital. Query-based exchange can help providers obtain prenatal care records so they can make safer decisions for the mother and her baby.

In all of these scenarios, you can see how health information exchange would result in better patient care, improved outcomes, and lower costs – moving us closer to our goal of the Triple Aim. Keep reading for a look at the evolution of HIEs, their benefits, and where they go from here — as well as how Health Gorilla’s interoperability solutions are powering health information exchange nationwide. 

The History of HIEs

HIEs are also sometimes referred to as Health Information Networks (HINs), Health Information Organizations (HIOs), and were originally known as regional health information organizations (RHIOs) and community health information networks (CHINs).

The Health Information Technology for Economic and Clinical Health (HITECH) Act, passed in 2009, provided more than $35 billion in incentives to promote and expand the adoption and use of EHRs, as well as funding for states and their state-designated entities (SDEs) to support statewide HIE services and encourage a nationwide model of change. 

In 2010, the ONC announced the State Health Information Exchange (State HIE) Cooperative Agreement Program awardees, which funded states, eligible territories, and qualified State Designated Entities (SDEs) to develop systems that would allow the exchange of clinical information electronically. HIEs, and the structure they've put in place, immediately enhanced the completeness of patient records and improved interoperability.

In addition to facilitating the exchange of clinical information nationwide, state and regional HIEs are now aggregating disparate EHR data, making it more reliable and actionable. They also support advanced analytics that contribute to data insights that improve operational and clinical outcomes.

There are several things that differentiate HIEs from one another:

  • Geography: Some HIEs serve a small geographic region, while others serve an entire state or multi-state region.
  • Structure: There are HIEs that act as conduits of health information and others that serve as repositories of health data.
  • Governance: A wide variance exists in the types of clinical data exchanged, services offered, and legal infrastructure associated with HIEs.

Leading the charge in interoperability on a national level, Carequality, CommonWell Health Alliance, and eHealth Exchange each began developing frameworks to facilitate secure exchanges between networks and quickly became the three largest public HINs in the country. Today, they provide connections and/or memberships to their services to organizations that satisfy their permitted exchange purposes and facilitate data exchanges across the country — primarily for query-based use cases. 

Unfortunately, for digital health companies, payers, hospitals, and other healthcare providers to have complete access to clinical data, they often must build one-off connections with each HIN, which is expensive, time-consuming, and resource-intensive. Health Gorilla, one of the only companies with memberships and connections to Carequality, CommonWell, and eHealth Exchange, is working to make it easier for the entire healthcare ecosystem to seamlessly share clinical data and aggregate each patient's complete clinical history in one place. 

HIEs and Value-Based Care

While the universal adoption of electronic record systems was an excellent start, this was only the first step. EHRs are doing their job well, capturing and storing patient information digitally, but the technology falls short in other areas. When it comes to generating data that can be leveraged to improve clinical outcomes and drive down costs to support the delivery of value-based care, it’s not enough. EHR interoperability is still hampered by increasingly disparate, disconnected data, making it difficult to get reporting and compliance information mandated by value-based care programs.

Value-based care, a form of reimbursement that ties payments for care delivery to the quality of care provided and rewards providers for efficiency and effectiveness, is seen as a viable replacement for the fee-for-service reimbursement model, which pays providers for services delivered based on bill charges or annual fee schedules.

But this model depends on healthcare’s ability to find and fill gaps in patient health information and get real-time access to patient information. Great strides have been made in this area with HIEs playing a major role in making value-based care work by enabling better decisions and care coordination, as well as:

  • Reduced readmissions and medication errors.
  • Improved diagnostic accuracy.
  • Decreased duplicate testing.

Gaps in interoperability have real consequences, some minor and others life-threatening. During the COVID-19 pandemic, it became clear that there was a need for public health reporting of test results and immunization data. Medical record access became more important as care shifted to telehealth or patients were routed to alternative facilities due to full hospitals. Discrepancies in health equity were also exposed, spurring a renewed call for social determinants of health (SDOH) data. HIEs hold real promise for meeting these needs and increasing the value that we as a nation are getting for our healthcare dollars.

Health Gorilla and HIEs

Health Gorilla is proud to support HIEs, which play a critical role in our country’s healthcare ecosystem and are at the forefront of promoting nationwide interoperability. Using our industry-leading Health Interoperability Platform (HIP), HIEs can:

  • Enrich current patient data. Leverage a state-of-the-art data processing engine to enrich and normalize data into an actionable format.
  • Improve care coordination. With clinical and SDOH data in one place, care teams can pull in the context they need and focus on what’s really important — patients.
  • Facilitate lab and radiology orders. With a national lab ordering network at their fingertips, HIEs can offer value-added upsell opportunities to the hospitals and labs in their community.
  • Help control costs. With a top-of-the-line data processing engine, HIEs can redistribute resources and place additional emphasis on their region's community health.

Our suite of products has been developed to improve the quality, safety, and efficiency of healthcare with standardized data attributed to the correct patient. This includes the HIP, which offers access to our national Master Patient Index and Record Locator Service, and Patient360, a patient data querying engine.. We also help HIEs avoid costly and time-consuming lab integrations by  centralizing their diagnostic ordering with Lab Network, a tool connected to major labs, including LabCorp, Quest Diagnostics, and BioReference.

Health Gorilla is proud to have implemented the first TEFCA-powered HIE in Puerto Rico. On July 1, 2021, our team launched the Puerto Rico Health Information Exchange (PRHIE) in collaboration with the Puerto Rico Department of Health. The PRHIE, which adheres to the known 21st Century Cures Act and TEFCA requirements, has brought forward a new era of interoperability for Puerto Rico by streamlining care, reducing costs, empowering patients and providers, and giving public health officials the necessary data to act decisively. 

Today, we act as the single-source provider of Health Information Exchange for the Puerto Rico Department of Health and operate as the HIN connecting payers, labs, providers, patients, and public health officials. The PRHIE includes more than 800 care sites, 12,000 providers, and connects more than 2.1 million patients, enabling patient medical record data to be shared securely and electronically. It’s a great example of a commercial entity and government organization coming together to benefit the entire healthcare community. 

Earlier this year, Health Gorilla announced our intention to become one of the first designated  Qualified Health Information Networks (QHINs) under the Trusted Exchange Framework and Common Agreement (TEFCA). Our work is ongoing with The Sequoia Project, the recognized coordinating entity for TEFCA, to execute the goals of the 21st Century Cures Act and bridge the gap between the commercial sector and government.

Contact Us

If you are part of an HIE organization and need a better way to organize actionable data for improved clinical and operational outcomes, reach out to an expert today and learn how Health Gorilla can help.