What is an HIE?

What is an HIE?

So we’ve talked Federal Policy, APIs, Anti-Information Blocking, and Meaningful Use.

My next topic is particularly near and dear to me as I’ve spent the last 12 or so years of my life on it: Health Information Exchange (HIE).

What is it?

In short—it's a term that is used both as a verb and a noun, kind of like vacation. I think of HIE as an inclusive resort, where data flows like wine, moving around freely and is easily accessible by all who need it and are wearing the proper wristband (throwback to our OAuth Tech Talk!). Do I hear tropical music? Ah, I digress…

As a verb, it’s the electronic sharing of health-related data between two or more organizations facilitated by applied standards for use by a variety of stakeholders to inform health and care.

As a noun, it refers to organizations within the U.S. that provide health information exchange technology and services at a state, regional or national level and often work directly with communities to promote secure sharing of health data.

There’s different types of HIE Organizations, like:

Hybrid HIEs: Collaborations between organizations within a state or region, like an ACO and a vendor network or a PPS.

Private/Proprietary HIEs: Concentrated on a single community or network and often based within a single organization. These HIEs include overall management, finance and governance with examples like hospital/integrated delivery system networks, payer-based HIEs, Vendor based HIEs and disease-specific HIEs.

Regional/Community HIEs: Inter-organizational and depend on a variety of funding sources, with most being not-for-profit. Like HEALTHIX in New York City and HASA in San Antonio.

State-wide HIEs: Run by state governments or sometimes the state's designated entity. Some state-wide (and regional) HIEs use an umbrella approach and actually serve as the aggregator for disparate private health information exchanges. Let’s take a closer look at New York’s HIE for example.

The SHIN-NY is the Statewide Health Information Network for New York. In partnership with the New York State Department of Health, The New York eHealth Collaborative (NYeC) developed and manages the technology platform and funding that connects the six Regional Health Information Organizations  (in the Regional/Community Category above) that serve as Qualified Entities of the SHIN-NY. It also enables the sharing of data statewide, ensuring that the SHIN-NY provides access to a patient’s electronic medical records when and where they need it. This is near and dear to my heart as I worked on this at NYeC for seven years.  

On a national level, there are lots of key interoperability players you should know about (and many friends of Particle!) including:

• Care Everywhere
• Carequality
• CARIN Alliance
• Community Care HIE
• DirectTrust
• eHealth Exchange
• SHIEC Patient Centered Data Home™ (PCDH)
• Surescripts
• CommonWell Health Alliance

From this list, I want to offer you a little more information on two of the biggest players in the Federal Interoperability space: CommonWell Health Alliance and Carequality.  While it's debatable as to whether these organizations are noun HIEs, they do provide verb HIE across the country and are some of the key partners that we work with to enable data exchange.

The Commonwell Health Alliance, importantly, offers a national interoperability infrastructure. CommonWell is one of the largest health data networks in the U.S. and composed of a group of active EMR companies and Health IT vendors. Change Healthcare has been servicing the organization for many years, providing services that enable things like an End-Point Directory, Record Locator Service, Security, and the actual mechanisms for data exchange. Here are some very special things Commonwell does:

• Patient Identification & Linking: matches patients and links each individual’s clinical encounters across the care continuum to the individual in Commonwell.  
• Record Locator Service: enables practitioners and patients to efficiently discover where a person’s data might be found by creating a “virtual table of contents” that specifies where patient data is available nationwide. This allows for a searching entity to be able to find exactly the information they want for the patient they want - using the above previously described  patient matching to make sure that they find the right person.
• Data Broker: enables caregivers to search, potentially select and receive needed data across a trusted network.
• Trust Fabric: CommonWell has governance, policies and procedures in which the adopters of the service agree to operate.

‍Carequality, is a non-profit, national-level, consensus-built, interoperability framework that enables exchange between and among health information networks and service platforms. Carequality unites these technologies and promotes interoperability among them with a common set of rules of the road and technical standards. Unlike CommonWell, Carequality is not exactly a technology-based data exchange but rather a contractual and operational framework that Particle Health, our partners, and customers use to share information with members of other networks.

Carequality’s framework covers some of the biggest EHR vendors out there. When we are able to pull records from systems such as Epic and Athena Health, its because we’ve done the work with integrating with systems across the country as part of the Carequality network. A big difference from Commonwell described above is that within Carequality, ach entity connected with the network does their own Patient Matching and instead of using a common RLS, we’ve built a proprietary RLS to help figure out who to query for records. The network is built on top of committee-based standards, IHE Profiles, and SOAP APIs, we’ve done all the detailed work of integration so that we can help our developer customers with a simple API with just a few data elements needed—to access and share data to build new and innovative solutions.

Next time, we’ll explore Patient Matching. My absolute favorite topic in the world. Ask anyone at Particle.

(I’m serious.)