Health Information Exchange in Primary Care

Health Information Exchange in Minnesota and Arkansas

In the Archives of Internal Medicine, a bi-monthly professional medical journal published by the American Medical Association, an article was published April 12th, titled “Health information exchange: participation by Minnesota primary care practices.” Here is the abstract:

Abstract

BACKGROUND: The American Recovery and Reinvestment Act of 2009 will provide $36 billion to promote electronic health records and the formation of regional centers that foster community-wide electronic health information exchange (HIE) with the ultimate goal of a nationwide health information network. Minnesota’s e-Health Law, passed in 2007, mandates electronic health record and HIE participation by all clinics and hospitals. To achieve these goals, small primary care practices must participate. Factors that motivate or prevent them from doing so are examined. METHODS: From November 10, 2008, through February 20, 2009, we gathered data (through questionnaires and interviews) from 9 primary care practices in Minnesota with fewer than 20 physicians and with varying degrees of electronic health records and HIE involvement. RESULTS: No practice was fully involved in a regional HIE, and HIE was not part of most practices’ short-term strategic plans. External motivators for HIE included state and federal mandates, payer incentives, and increasing expectations for quality reporting. Internal motivators were anticipated cost savings, quality, patient safety, and efficiency. The most frequently cited barriers were lack of interoperability, cost, lack of buy-in for a shared HIE vision, security and privacy, and limited technical infrastructure and support. CONCLUSIONS: Currently, small practices do not have the means or motivation to fully participate in regional HIEs, but many are exchanging health data in piecemeal arrangements with stakeholders with whom they are not directly competing for patients. To achieve more comprehensive HIE, regional health information organizations must provide leadership and financial incentives for community-wide meaningful use of interoperable electronic health records.

SHARE

The Arkansas State Health Alliance for Records Exchange (SHARE) is seeking informational responses (PDF) regarding creation and implementation of an interoperable health information exchange structure for the State of Arkansas. The Arkansas Coordinator for Health Information Technology is seeking this information on authorization from the Arkansas Department of Finance and Administration, the state-designated entity for Arkansas’s Health Information Exchange (HIE).

HIE Design Principles and Requirements

1. The HIE will be “vendor neutral,” i.e., vendor products must be non-proprietary and interoperable with others.
2. The HIE will rely upon a network, or infrastructure, to provide service functionality.
3. The HIE will be a “hybrid” architecture; not completely federated nor centralized. In the development of a phased implementation, it may be practical to start with a centralized architecture and evolve to a “hybrid” architecture.
4. The HIE will be focused on facilitating exchange of information, rather than the end user application functionality.
5. The HIE will support construction and aggregation of the longitudinal patient record for secure sharing among authorized users across the network.
6. The HIE will comply with current interoperability standards available in the market today.
7. The HIE will interoperate with existing community and private health information exchanges as well as the NHIN infrastructure.
8. The HIE technical architecture will be scalable and expandable.
9. The HIE will utilize standard security protocols supporting user authorization, authentication, non-repudiation, encryption, and administration. It also should support security auditing functions.
10. The HIE will utilize standard data storage and management protocols normally associated with large information technology solutions and available in the market today.
11. The HIE will be supported by industry standard business continuity and disaster recovery infrastructure and processes.
12. The HIE must be compliant with the accessibility requirements as defined in Arkansas Act 1227 of 1999.

Descriptive  Information About the Arkansas HIE

The technical infrastructure of the Arkansas HIE will support recognized data standards, code sets, and exchange standards for each component architectural layer. Those layers include technical, privacy and security, administrative context, clinical context, and the Nationwide Health Information Network (NHIN). The HIE will be designed to permit participants (clinical and administrative) to incrementally migrate from a basic exchange to full integration as national, state, and user-based standards and associated technologies evolve. The role of the HIE will be to incorporate data from many sources and formats as standards and technologies evolve to facilitate exchange and to meet national standards.
The HIE will seek to capitalize on existing community, private, and public, health information exchange capabilities to build a statewide HIE. The HIE will participate with other participants in the NHIN to facilitate and promote care coordination with local Veterans Administration, Indian Health Services, public health, and Department of Defense (DOD) military health systems. (There are no Indian Health Services entities within the State of Arkansas.) As previously mentioned, the HIE will coordinate with Medicare and Medicaid in support of information exchange and interoperability.

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