Health Information Exchange
You may find yourself asking questions about health information exchange, such as “what is health information exchange?” and “is it safe?” This paper will focus on both of those questions, and more, to give you a better understanding of health information exchange.
Concept, Structures, and Types of Health Information Exchange
Health information exchange is exactly what it sounds like. It is a way for healthcare professionals to share healthcare information about a patient across different healthcare organizations. This is done electronically through different information systems. A great example to better understand this is the doctor electronically sending a prescription to the pharmacy. Of course, this isn’t the only way health information is exchanged through systems, but it is the best way to visualize and understand it.
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There are three forms of health information exchange. The first form is directed exchange, which is the ability to send and receive secure information electronically between care providers to support coordinated care. The second form is query-based exchange, which is the ability for providers to find and/or request information on a patient from other providers. The third form is consumer-mediated exchange, which is the ability for patients to aggregate and control the use of their health information for providers. Electronic health information exchange is always done securely. Each health system and healthcare provider must take precautions to ensure the data is shared through encrypted methods.
Benefits and Challenges
There is a plethora of benefits for health information exchange. The benefits aren’t just aimed at one particular group of people, either. Enhanced patient care coordination, elimination of unnecessary testing, increased patient safety, less medication and medical errors, and improved efficiency in the healthcare system are just a few of the benefits. As you can see, these benefits range from physician, to pharmaceutical staff, to patient, and so on.
There are quite a few challenges of health information exchange, as well. One of those challenges is patient identity. If the data is incorrectly collected, entered, and queried, the integrity of the patient data could be compromised. Another challenge, which is something I personally have been running into at my workplace, is patient consent. Many people are wary of giving consent to having their personal information released, whether it be a patient portal or electronically sending the information to another practice. Lastly, a glaringly obvious challenge, is security. Any healthcare organization participating in an electronic health record system and health information exchange must be thorough in protecting patient’s personal information. A survey was done in 2017, and it was found that 87 percent of adults were unwilling to divulge all their medical information. This is due to a growing number of cybersecurity attacks that compromise personal information.
The Role of Clinical Terminologies and Data Standards and the Significance of Data Quality Characteristics in Health Information Exchange
There are many different types of clinical terminologies used in health information exchange – SNOMED, CPT, LOINC, ICD just to name a few – but not all have been adopted and implemented. Having these standardized terminologies helps to provide a foundation for interoperability and keeps everything structured. Just imagine how difficult it would be if clinical terminologies weren’t used! There would be no structure or organization in the healthcare field and the reimbursement process for the physicians would be much more delayed.
There are ten characteristics of data quality in health information exchange. Each one of these characteristics are important to maintaining the integrity of data quality: accuracy, accessibility, comprehensiveness, consistency, currency, definition, granularity, precision, relevancy, and timeliness. As you are about to see, these ten elements are crucial to data quality.
Accuracy is the focus on the data being free of errors, if there were errors in the data then patient care could be hindered. Accessibility is where proper safeguards are established and employed to assure the data is available when needed. A great way to think about accessibility is that a practitioner must be able to access the health records of all patients they are currently treating. Comprehensiveness is where all required data elements that should be collected throughout the health records are documented. In comprehensiveness, the entire staff of the practice should be trained on what required elements should be collected during the encounter. Consistency ensures all patient data is the same throughout the encounter, an example would be a test result and a diagnosis should be the same throughout the record. Currency means the record is current and up to date. Anything out of date, such as discontinued medication, should be updated to reflect the discontinuation. Definitions should be in place to ensure all data elements are clearly defined, such as defining “date of birth” as MM-DD-YYYY. Granularity is the data collected for patient care must be at the appropriate level of detail. Precision entails the data being precise, such as not “rounding up” when taking a patient’s weight. Relevancy is the extent to which the data elements being collected are useful for the purposes that they are collected. If the patient is in for chest congestion, there would be no relevant reason to test for a urinary tract infection. Finally, timeliness is ensuring the information is entered promptly. If the information is not entered in a timely manner, then details could be missed.
State-Specific Health Information Exchange Findings
In New Jersey, there is a statewide health information exchange network that was launched relatively recently, as well as smaller health information exchange networks. The New Jersey Health Information Network is also looking to eventually exchange health information nationally with eHealth exchange. The current focuses include a statewide admission transfer notification service that could improve post-discharge outcomes, a common key service which provides a consistent and reliable way to match patients across multiple organizations, a health provider directory service, and a state health data hub. Another really interesting project is one that could help providers reduce the problems associated with opioid over-prescribing.
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In Southern New Jersey, we have a great technology called NJSHINE. NJSHINE connects patient medical records in seven counties with some of the biggest organizations in the southern part of the state (Cape Regional Health System, Inspira Health Network, Atlanticare, and Shore Medical Center just to name a few). Providers can access lab results, radiology reports, and medication lists. Patients can access the patient portal which is useful in managing information and care received at the healthcare organizations.
My Personal Interest in Health Information Exchange as a Consumer
Personally, I think health information exchange is a great and necessary tool. I work in a physician’s office, and I regularly use NJSHINE to help obtain medical data that the providers need on patients. As a patient, I find it useful to be able to tell my provider that my blood work was taken at Cape Regional Hospital, and they can pull up the results within minutes. It is a great tool that is evolving day by day and gaining popularity. I think the benefits outweigh the challenges, and with technology growing every day, we can create a system that could not be compromised due to a cyberattack.
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