Health information exchange (HIE) is the mobilization of health care information electronically across organizations within a region, community or hospital system. Participants in data exchange are called in the aggregate Health Information Networks (HIN). In practice, the term HIE may also refer to the health information organization (HIO) that facilitates the exchange.

The goal of HIE is to facilitate access to and retrieval of clinical data to provide to public health authorities in analyses of the health of the population.

Formal organizations support financial statewide health information exchange grants from the Office of the National Coordinator for Health Information Technology. These grants were legislated into the HITECH components of the American Recovery and Reinvestment Act of 2009.^[1] The Regional Health Information Organizations, or RHIOs, are ordinarily geographically defined entities which develop and manage a set of contractual conventions and terms, arrange for the means of electronic exchange of information, and develop and maintain HIE standards.^[2]

In the United States, federal and state regulations regarding HIEs and health information technology (HIT) are still being defined. Federal regulations and incentive programs such as "Meaningful Use", which is formally known as the EHR Incentive Program,^[3][4] are changing. The vast majority of HIEs and RHIOs remain tied to federal, state, or independent grant funding in order to remain operational. Some exceptions exist, such as the Indiana HIE.^[5][6]

Storage and gathering of information

Data architecture models

In a centralized model of HIE, there is a central (or master) database that holds a copy of all of the records of every patient contained. In a federated model of HIE, there is no master database.

In a centralized model, patient information is uploaded to a single database from which any provider in the HIE can download. In a federated model, records are exchanged electronically among providers when they need them.^[7][8]

Patient consent

Exchanges in the US must operate with patient consent to comply with not only the Health Insurance Portability and Accountability Act (HIPAA) and also variety of state and federal laws and regulations. This was clarified by the Office of Civil Rights in the January 2013 Final Omnibus Rule Update to HIPAA.^[9]

There are two methods for gaining patient consent. One is explicit consent and is termed opt-in. With this method, a patient is not automatically enrolled into the HIE by default and generally must submit a written request to join the exchange.

The other method is implicit patient consent and is termed opt-out. In this method, patients give implicit consent to join an HIE when they agree to use the services of a health care provider who is submitting data into an HIE and sign the provider's Notice Of Privacy Practices. Patients can request to opt out of the HIE, generally with a written form.^[10]

Notable European health information exchanges

Netherlands

Frysian Health Information Exchange

Connects Medical Centre Leeuwarden and Academic Center in Groningen with community hospitals like Nij Smellinghe Hospital in Drachten.^[11][12]

The Friesland Regional Cardiology Network reduces the length-of-stay for patients in hospitals by one or two days.^[12] Once the records were uploaded to the cardiology network, records remain available for consultation at any time so that previous episodes of a patient's care can be consulted.

North of the Netherlands – XDS Network

Hospitals in the Dutch provinces Groningen, Friesland and Drenthe have created an (diagnostic) image exchange network in order to phase out CD/DVD based exchanges using an IHE (XDS) platform. St. Gerrit, the local HIE organization, has gradually expanded the network since 2014, spanning 10 hospitals to date.

Other

• ZorgNetOost^[13]
• Radboud University Medical Center
• Limburg Exchange Network – Maastricht University Medical Center, Maastro Radiation Therapy Institute, Laurentius Hospital
• Image Exchange South East-Brabant – Maxima Medical Center, Elkerliek Hospital, Catharina Hospital Eindhoven, St. Anna Hospital
• Regional Exchange Network West-Brabant^[14]
• Image Exchange Network Breda – Amphia Hospital, BVI,^{[expand acronym]} Elisabeth-TweeSteden Hospital^[15]
• Rotterdam Exchange Network RijnmondNet^[16]
• TRIJN^[17]
• Zorgring Noord-Holland Noord^[18]

United Kingdom

• Sussex and Surrey
• Bristol
• Great Ormond Street Hospital

Ireland

• NIMIS

Finland

• Helsinki-Uusimaa Health district

Notable United States health information exchanges

Individual exchanges

Chesapeake Regional Information System for our Patients

CRISP is a non-profit corporation that is implementing health information exchange in the state of Maryland. The organization also serves as the Health IT Extension Center for Maryland. CRISP was created by Johns Hopkins Medicine, MedStar Health, the University of Maryland Medical System and Erickson Retirement Communities.^[19] Audacious Inquiry, a health information system consulting firm, serves as the technical architect and strategic partner for the health information exchange while Dynamed Solutions provides operational, project management and organizational support under CRISP.

Health Current

Health Current, formerly Arizona Health-e Connection (AzHeC), is the health information exchange (HIE) that shares information across Arizona.^[20] Health Current grew out of a gubernatorial executive order in 2007.^[21]

Delaware Health Information Network

Delaware Health Information Network (DHIN) is a non-profit public-private partnership enacted by the Delaware General Assembly in 1997. DHIN has adopted regulations to govern its operations and has policies and procedures. DHIN started in May 2007. In February 2012, The Delaware Health Information Network announced full participation of all acute care hospitals and skilled nursing facilities in the state, along with the vast majority of Delaware providers, in the first statewide community health record. As of June 2013, DHIN has the participation of 97 percent of Delaware providers, tracks around 88 percent of Delaware's population, and delivers more than 10 million clinical results and reports to participating providers annually.^[22]

Idaho Health Data Exchange

The Idaho Health Data Exchange (IHDE) is the state designated Health Information Exchange (HIE) for Idaho. Health Information Exchange enables doctors, nurses, labs, and other medical providers to securely access their patient's electronic health information quickly, 24/7/365. IHDE is a non-profit 501(c)(6) company. Located in Boise, Idaho, the staff consists of an Executive Director, Executive Assistant, Sr. Marketing Coordinator, Business Analysts (Implementations), Training/Support Specialists, and IT systems support. Members of the Board of Directors and Privacy and Security Committee represent the private and public sectors, and delivery systems.^[23]

Indiana Health Information Exchange

The Indiana Health Information Exchange (IHIE) operates the U.S.' largest HIE and one of the oldest with data on more than 7 million patients. Created by the Regenstrief Institute, a medical informatics think tank, the Indiana Network for Patient Care (INPC) is a secure network that provides patient records to participating doctors. This HIE grew from 12 hospitals in the center of the state with approximately 5,000 physicians, to 106 hospitals out of 126 in the state and more than 14,000 physicians in Indiana.^[24]

Ohio Health Information Partnership

The Ohio Health Information Partnership (with CliniSync; HIE) is a nonprofit, public/private partnership initially funded with $14.8 million in federal HITECH funds under the Office of the National Coordinator for HIT. It is the state-designated statewide health information exchange founded by the Ohio State Medical Association, the Ohio Osteopathic Association, the Ohio Hospital Association, BioOhio and the Ohio Department of Insurance.^{[citation needed]} CliniSync is an independent nonprofit founded in 2009.^[25] It received $43.8 million in HITECH funding.^[25]

Federal funds paid for the creation of the technological infrastructure, powered by Medicity, as well as discounted implementation fees for hospitals in Ohio.^{[citation needed]} As of 2016^[update], CliniSync has 148 hospitals contracted, with 123 "live," and over 400 long-term and post-acute care facilities.^[25]

In 2015, CliniSync enabled practices and other authorized users to look up and find (query and retrieve) a longitudinal Community Health Record on a patient.

CliniSync members will receive notifications when a patient is discharged or admitted to the hospital or Emergency Department in late 2016.