Section1.8 Assess

Section 1 Assess—HIE Technology Readiness Inventory - 1

HIE Technology Readiness Inventory

Understand health information exchange (HIE) definitions and technology. Assess your skilled nursing facility’s readiness to utilize the HIE Service Provider (HIESP) that meets your needs.

Time needed: 2 hours to read this document, up to 8 hours to complete the linked readiness checklist.
Suggested prior tools: 1.10 Interoperability for EHR and HIE
Assumed Knowledge: EHR Basics

How to Use

1.Review basic definitions and standards associated with HIE.

2.Review the forms HIE can take, and the technology used in each.

3.Follow the link to the HIMSS readiness checklist to identify all types of health information exchange in which your facility is interested. Use this checklist when evaluating HIE options within your area.

Basic Definitions

Health Information Exchange (HIE): In its Practical Guide to Understanding HIE[1] , the Minnesota Department of Health defines HIE as: “HIE refers to the secure electronic sending and receiving of clinical health information in ways that the information can be understood by both the sender and the receiver of the information.”

The federal government provides this definition on HealthIT.gov “Electronic health information exchange (HIE) allows doctors, nurses, pharmacists, other health care providers and patients to appropriately access and securely share a patient’s vital medical information electronically—improving the speed, quality, safety and cost of patient care” (HealthIT.gov, 2014).

Standard: “A standard…provides requirements, specifications, guidelines or characteristics that can be used consistently to ensure that materials, products, processes and services are fit for their purpose” (iso.org, 2014).

Standards are important because without them, different EHR systems are unable to communicate with one another, therefore making “exchange” of information between different providers and caregivers impossible. In a perfect world, standards precede exchange. Historically, in the real world, there has been slow development of standards, and slow movement to adopt shared standards. Different vendors and organizations have programmed their systems to different (or non-established) standards. The passage of the HITECH Act and Meaningful Use criteria requires vendors and organizations to use standards in their EHRs and for HIE. This is notable, because while many types of health care providers impacted by Minnesota’s 2015 Mandate for Interoperable Electronic Records [2], meaningful use incentives are available only for eligible hospitals and providers. EHR vendors are building standards into their EHR products to meet MU requirements, which in turn benefits healthcare organizations that are not eligible for MU incentives.

Definitions Specific to HIE

There are three types of standards associated with HIE:

1.Transaction standards

2.Semantic standards

3.Process standards

Transaction standards define which data fields are transmitted and how they are organized for transmission. There are many transaction standards that are specific to the healthcare domain. These transaction standards can be further divided into message formats (how the message is “put together”, message transport (how the message is transmitted), and message security (keeping the data private and secure during transmission).

Semantic standards are probably the most recognizable of standards to clinicians. Semantic standards define the range and meaning of variables (pieces of data) being transmitted. Some examples commonly found in health care are:

Adapted from: HIMSS’ HIE inPractice: Foundation Series, 2013

Process standards refer to how work processes are completed in a setting. This is where the term “workflow” comes in. For example, the workflow for admitting a patient exists in some care settings (inpatient, rehabilitation facility, long term care facility, home health), but not in others (ambulatory clinic). Different workflows in different care settings require the content of messages to be constructed in different ways so that the right data land in the right spot from transmission to receipt.

Forms of HIE and Associated Technology:

1.Direct exchange (secure messaging through an HIE) is used by providers to easily and securely send health information—such as lab orders and results, referrals, prescriptions, or dischargesummaries—directly to another provider, and increasingly to patients. Direct is also being used for sending immunization data to public health organizations and to report quality measures to the Centers for Medicare & Medicaid Services (CMS). Although many providers use a dedicated virtual private network (VPN) to transmit claims to health plans (or billing information to billing services and/or health care clearinghouses), directed Direct could also be used for this purpose. Direct is sometimes is referred to as Push, where information is exchanged between two entities with an established relationship for routine workflow and processes.This exchange can be conducted over the Internet (rather than through a VPN)using the Direct protocol—a federally approved, secure means to exchange email. (See Section 4.10 Using Direct for HIE).

2.Query-based exchange is used by providers to search and discover accessible information about a client. This type of exchange, also referred to as Pull, is often used when there is an unplanned episode of care, such as by an emergency department or behavioral health specialists seeking information on what medications a patient is taking, or by a hospital presented with a woman in labor and needing pre-natal care information from an obstetrician or local public health clinic. Such an exchange requires the use of an established health information exchange service provider (HIESP) and a form of secure communication called CONNECT. This form of exchange supports a variety of technical services (described below) including client consent management and the ability to provide Pull and Push services in a subscription mode. For example, a provider may arrange for a continual update to a client’s medications. (See Section 4.11 Using CONNECT for HIE.)

3.Consumer-mediated exchange provides clients with access to their health information, allowing them to manage their health care online in a similar fashion to how they might manage their finances through online banking. The federal government is a strong supporter of such exchange. The healthIT.gov website describes that “When in control of their own health information, patients can actively participate in their care coordination by providing other providers with their health information, identifying and correcting wrong or missing health information, identifying and correcting billing information, tracking and monitoring their own health” (see: http://www.healthit.gov/providers-professionals/health-information- exchange/what-hie).

Consumer-mediated exchange may be accomplished through a personal health record that is tethered to a provider or health plan, or is a commercial product. The federal government (Medicare, Department of Defense, and Veterans Administration) and other health plans are adopting Blue Button® technology. Originally, Blue Button supported only the downloading of human-readable data in ASCII format. Since January 2013, the Office of the National Coordinator for Health Information Technology (ONC) announced Blue Button+, which enables both human-readable and machine-readable formats for the data being exchanged.

The Minnesota HIE Landscape:

In Minnesota, there are twwo types of HIE Service Providers who have been granted a Certificate of Authority to operate:

  • Health Information Organization (HIO): An entity that provides all electronic capabilities for the transmission of clinical transactions necessary for “meaningful use” of electronic health records, in accordance with nationally recognized standards (
  • Health Data Intermediary (HDI): An entity that provides the infrastructure to connect computer systems or other electronic devices used by health care providers, laboratories, pharmacies, health plans, third-party administrators, or pharmacy benefit managers to facilitate the secure transmission of health information, including pharmaceutical electronic data intermediaries as defined in Minn. Stat. §62J.495, and Health Internet Service Providers (HISP) as defined by the Nationwide Health Information Network (NwHIN) Direct Project. Please note, to the extent that information is shared without the use of an intermediary it is outside the scope of Minnesota's oversight law (

Tools:

The Minnesota Department of Health has published an online “Practical Guide to Understanding HIE, Assessing Your Readiness and Selecting HIE Options in Minnesota”. A printable version of the publication is available at Checklist

HIMSS has put together a “checklist” that organizations can use to step through various clinical scenarios to identify detailed technology needs in order to prepare for HIE. This checklist is long and comprehensive. Not all steps will be appropriate for your organization. Nonetheless, read all the entries and work through those that apply to the types of exchange you want to pursue.

References:

Healthit.gov (2014). What is HIE (Health Information Exchange). Accessed January 28, 2014 from: http://www.healthit.gov/providers-professionals/health-information-exchange/what-hie.

HIMSS.org (2011). HIE technical architecture checklist. Accessed January 28, 2014 from: (2014). HIMSS HIE common practices survey. Accessed January 28, 2014 from: (2014). ISO standards-ISO. What is a standard? Accessed January 28, 2014 from: src="C:\ExportImg\ccde747dc011e2b1987ee30f72eb1a3e\Aspose.Words.f46defc3-a3ce-4b0e-9664-94ec35328877.004.jpg" width="654" height="213" alt="" style="margin-top:12.5pt; margin-left:-8.5pt; -aw-left-pos:-7pt; -aw-rel-hpos:column; -aw-rel-vpos:paragraph; -aw-top-pos:14pt; -aw-wrap-type:none; position:absolute">Copyright © 2014 Updated 03-19-2014

Section 1 Assess—HIE Technology Readiness Inventory - 1

[1] Refer to: