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Implementing a Health Information Exchange in a small healthcare facility

Chris Lindsey

INFM 210

Dr. H. Frank Cervone

May 16, 2021

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What is Health Information Exchange (HIE)?

Sharing of medical information between hospitals, clinics, and public health facilities
Improves the speed, quality, safety, and cost of patient care

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How do we currently store and exchange health information?

Currently, most Americans’ medical information is stored on paper (HealthIT.gov, 2020)
Medical information is usually shared by…

Mail
Fax

Medical information is most commonly shared by…

Patients carrying paper records from appointment to appointment

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Imagine being able to pull up a patient’s entire health record up with the touch of a button

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Why? �To decrease duplicate testing

1 in 5 hospital radiology tests are duplicates

This wastes $20 billion annually

32% of cases studied contain duplicate testing

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Other reasons to implement an HIE…

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Avoid

Avoid readmissions

Avoid

Avoid medication errors

Improve

Improve diagnoses (HealthIT.gov, 2020)

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HIE Enables Telehealth

Talk to a doctor over phone or videochat
Send and receive messages
Use remote patient monitoring

(HHS.gov, 2021)

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“Telehealth — sometimes called telemedicine — is the use of electronic information and telecommunication technologies to provide care when you and the doctor are not in the same place at the same time” (HHS.gov, 2021). Telemedicine has been called “the backbone to HIE” (Prestigiacomo, 2013)

Implementing a Health Information Exchange generally goes hand in hand with implementing Telehealth system. This is because a Health Information Exchange allows and enables the transfer of information between Telehealth devices. In short, we can’t have devices transferring private health information to another facility unless there is already a safe and legal health information exchange in place.

Telehealth enables our healthcare providers to:

Talk to a doctor over the phone or videochat
Send and receive messages between doctor and patient
Use remote patient monitoring (HHS.gov, 2021)

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Use case #1: After-hours Psychiatric Evaluations

Not possible when there isn’t a qualified professional present

Solutions:

Perform evaluation via Telehealth systems
HIE allows us to see if a diagnosis has already been made by our local PHF or by another hospital in our county

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One issue that keeps coming up again and again in our small, community hospital is what to do when the police bring a psychotic patient to the emergency room in the middle of the night and we can’t hold them or give them medication without a proper diagnosis from a qualified care provider. There are two solutions that a HIE program can provide:

Recently, “California lawmakers have amended a long-standing law regulating involuntary commitment to a mental health institution to allow psychiatric evaluations to be done by telehealth” (Wicklund, 2021).
If we share electronic health records with one of our local PHFs (psychiatric health facilities), then when we get a patient in the midst of a mental health crisis, we can quickly and easily find out if they already have a diagnosis. As we all know, a person in the throes of schizophrenic psychosis will usually not volunteer their past diagnoses (or even recognize these diagnoses as legitimate)

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Use case #2: Unresponsive patient

HIE gives us access to an electronic health record to answer questions such as:

Is this person on any medications?
Are they diabetic?
Does this person have any food or medication allergies?
Does this person have a history of drug use?
Is there a family member we can contact?

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Next steps…

Review

Review HIE systems implemented by similar health care systems in similar counties

El Dorado County in California implemented a program with:

Assemble

Assemble a project team

Include representatives from participating facilities
Include IT and Informatics professionals

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Next steps…

Technology Review and Selection

Location, Modality of Exchange, and Type of HIE
Type of Data Exchanged
Services offered
Communication method

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For more information…�

Access El Dorado - http://www.acceledc.org/healthit.asp
Health Information Exchange (HIE): A Primer and Provider Selection Guide (Blais, et al, 2020): https://leadingage.org/health-information-exchange-hie-primer-and-provider-selection-guide
What is HIE? (healthIT.gov, 2020): https://www.healthit.gov/topic/health-it-and-health-information-exchange-basics/what-hie
What is Telehealth? (hhs.gov, 2021): https://telehealth.hhs.gov/patients/understanding-telehealth/
California Amends ‘5150 Hold’ Law to Allow Telehealth Evaluations (Wicklund, 2021): https://mhealthintelligence.com/news/california-amends-5150-hold-law-to-allow-telehealth-evaluations
Doing Away with Duplicate Testing Can Cut Healthcare Costs (DeMello, 2015): https://www.unh.edu/healthyunh/blog/healthcare-consumerism/2015/05/doing-away-duplicate-testing-can-cut-healthcare-costs

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References

Access El Dorado: Health IT. ACCEL: Health IT. (n.d.). http://www.acceledc.org/healthit.asp.

Blais, A. F., et al (2020). Health Information Exchange (HIE): A Primer and Provider Selection Guide. https://leadingage.org/health-information-exchange-hie-primer-and-provider-selection-guide.

DeMello, H. (2015, May 12). Doing away with Duplicate Testing Can Cut Healthcare Costs. Healthy UNH. https://www.unh.edu/healthyunh/blog/healthcare-consumerism/2015/05/doing-away-duplicate-testing-can-cut-healthcare-costs.

Prestigiacomo, J. (2013, June 24). Telemedicine as the Backbone to HIE. Healthcare Innovation. http://www.hcinnovationgroup.com/interoperability-hie/infrastructure/article/13019394/telemedicine-as-the-backbone-to-hie.

What is HIE? HealthIT.gov. (2020, July 24). https://www.healthit.gov/topic/health-it-and-health-information-exchange-basics/what-hie.

What is telehealth? Telehealth.HHS.gov. (2021, May 4). https://telehealth.hhs.gov/patients/understanding-telehealth/.

Wicklund, E. (2021, March 4). California Amends '5150 Hold' Law to Allow Telehealth Evaluations. mHealthIntelligence. https://mhealthintelligence.com/news/california-amends-5150-hold-law-to-allow-telehealth-evaluations.