Section 1.8 Assess
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
1
http://www.health.state.mn.us/divs/hpsc/ohit/hieguidance/intro.html
2
Refer to: http://www.health.state.mn.us/e-health/hitimp/
Section 1 Assess—HIE Technology Readiness Inventory - 1
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 health care 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:
Standard
ICD
CPT
Meaning
International Classification of Diseases
Current Procedural Terminology
Details
Published by the World Health Organization
Describes medical, surgical and diagnostic services.
Maintained by the
American Medical Association
HCPCS
Healthcare Common Procedure Coding
System
Based on CPT and designed to provide a standardized
coding system for describing the specific items and
services provided in the delivery of healthcare. Used
for reporting to Medicare, Medicaid and other payers.
LOINC
Logical Observation Identifiers Names
and Codes
Database and universal standard for identifying
medical
laboratory observations.
Developed by the Regenstrief
Institute.
SNOMED
Systematized Nomenclature of Medicine
A multi-axial, hierarchical classification system where
11 axes represent classification features
RxNorm
Standardized nomenclature for clinical
drugs
Produced by the U.S. National Library of Medicine
National Drug Code
Universal product identifier for human drugs.
NDC
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
discharge summaries—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
Section 1 Assess—HIE Technology Readiness Inventory - 2
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-informationexchange/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
(http://www.health.state.mn.us/divs/hpsc/ohit/certified.html).

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
Section 1 Assess—HIE Technology Readiness Inventory - 3
outside the scope of Minnesota's oversight law
(http://www.health.state.mn.us/divs/hpsc/ohit/certified.html).
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 http://www.health.state.mn.us/e-health/hitimp/index.html.
Readiness 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:
http://www.himss.org/files/himssorg/content/files/HIE/HIE_TechnicalArchitectureChecklist.pdf.
HIMSS.org (2014). HIMSS HIE common practices survey. Accessed January 28, 2014 from:
http://himss.files.cmsplus.com/HIMSSorg/Content/files/2013HIEApplicableStandardsOverview_1367503710340_2.pdf.
iso.org (2014). ISO standards-ISO. What is a standard? Accessed January 28, 2014 from:
http://www.iso.org/iso/home/standards.htm.
Copyright © 2014
Section 1 Assess—HIE Technology Readiness Inventory - 4
Updated 03-19-2014