Lecture 7
Health Information Exchanges
(Chapter 17)
http://www.csun.edu/~dn58412/IS531/IS531_SP16.html
Learning Objectives
1. Health Information Exchanges (HIE) and
Users
2. Key Factors in HIE
3. HIE Business Models
4. Driving Forces for HIE Development
5. Obstacles to HIE Development
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Health Information Exchange
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Health Information Exchange
• Electronic movement of health-related
information among organizations,
• A process within a state health information
organization or a regional health
information organization
• A bidirectional sharing of patient healthrelated information among providers and
other authorized healthcare professionals
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National Health Information
Network
• NHIN provides a standardized, secure, and
confidential way to link information
systems together for authorized users to
share reliable health-related information
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Users of Health Information
Exchanges
• Individual level: enhance personal health
outcomes
• Professional level: clinical decision making
• Agency/organization level : managing
operations and quality improvement
• Public health and national level:
accreditation bodies to evaluate
population health, health policy
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Architecture of
Heath Information Exchanges
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Key Issues in
Heath Information Exchanges
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Data storage
Master person index (MPI)
Record locator service
Authentication
Authorization
Security policies
Auditing and logging
Standards
Scope of services
Knowledge of workflow
Portals for access
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Data Storage
• To enable the aggregation of data from
many sources
• Infrastructure models
– Centralized
– Decentralized / federated
– Hybrid
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Centralized Data Storage
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Decentralized Data Storage
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Hybrid Data Storage
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Master Person Index (MPI)
• To uniquely identify an individual
• To match the person’s data from many
sources
• Could be a complex identifier with
multiple identification attributes (name,
DOB, address)
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Record Locator Service
• A service to search health information that
matches the identified individual
• Locator can point to a specific types of
information / criteria
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Authentication
• To identify authentic users to the systems
• Valid users: clinical professionals, public
health professionals, supporting IT
professionals
• Will include patients in future
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Authorization
• Authorized user matrix: WHO can access
WHAT information for WHAT purpose
• CRUD Function Matrix in database:
Create-Read-Update-Delete
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Security Policies & Procedures
• Agreement among organizations to share
patient data (retrieve, reuse)
• Track requests for information
(Require patient consent)
• Opt in vs. Opt out
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Auditing & Logging
• Keep track all accesses to network
services
– Intentional vs. unintentional
– Connection vs. disconnection
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Criteria-based Standards
• To assure the interoperability and reuse of
information from many sources
• Data communication protocols
• Data content, format
• Technical compatibility among systems
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Scope of Services Provided
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Knowledge of Workflow
• Data processing procedure (When, Who,
How)
• Patient data types (What, Whose)
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Portal for Access
• Different portals for different types of
information exchanges
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Health Information Exchange
Models
• Government-led HIE: direct government
program
• Public utility HIE: with government
oversight
• Private sector-led HIE: government as a
stakeholder for collaboration and
advisement
• Public authority HIE : a government
created nonprofit authority with powers to
operate in a business-like manner
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Health Information Exchange
Business Models
• Business models designed for financial
sustainability:
– Membership fee model
– Transaction fee model
– Program and service fee model
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Driving Forces
• Reduce data duplication and related costs
• Reduce discrepancies among information
from may sources and related fixing costs
• Provide a uniform holistic picture of the
patient’s health to improve care quality
• Underlying key success factor: Electronic
Health Records (HER) and Electronic
Medical Record (EMR) must be first broadly
adopted/implemented
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Current Obstacles
Size and scope of the project
Time / Costs
Critical mass of data to be exchange
Collaboration between competitors
(providers)
• Technical skills / necessary clinical
knowledge to use the system
• Resistance to change
• Composition and structure of governing
agency
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Future Directions
• Statewide HIE initiatives have started
– HIE enabler/readiness (coordinating initiaties)
– HIE outsourcing/technical partnership
(technology implementation and services)
– HIE operator (implementation and
management)
• A national health information network to
be build
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Some References
• http://c.ymcdn.com/sites/www.azhec.org/
resource/resmgr/Files/WP_HIE.pdf
• http://www.himss.org/resourcelibrary/Topi
cList.aspx?MetaDataID=1737
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