- By John Fraser

Last month we introduced the concept of Health Information Exchanges (HIEs), discussed HIE drivers and designs, how HIEs work, and how they connect. In this article, we’ll explore the common sense benefits of an HIE. It has become clear that HIEs need to deliver real value–otherwise if a Health Information Exchange is costly, and doesn’t provide value, why would anyone build one in the first place?

Before HIEs:
Anyone who has been referred to a new doctor and had to fill out forms, (again!) including pages of detailed health information, understands the value of sharing information between doctor’s offices. The ability to refer a patient from one provider to another (while sending along medical information) is a critical part of an HIE. The new provider needs to have enough information to provide a continuous high quality of care, based on existing medical information (called “continuity of care”).

Specifically, the inability to share even basic medical information can be tragic in emergency situations. Without a Health Information Exchange to share information quickly, response to accidents can be very low-tech. After a car accident, for example, a 911 call usually results in an ambulance sent to the scene of the accident. Once the ambulance arrives, the crew is poorly equipped to treat the victims, since they usually don’t have specific individual information (and are missing information such as allergies, medical devices, drugs, emergency contacts, etc). The emergency staff of a large hospital recently stated that they ‘can only provide minimal drugs or other treatments for fear of triggering an allergy or other bad outcome’. This is today’s state of healthcare!

Let’s now consider how accident response could be vastly improved utilizing an HIE and technology. Consider the emergency response if an accident happens in northern Minnesota, within the fully interconnected HIE of that region. Once a 911 call is made, the 911 operator begin a workflow using electronic tools provided by the HIE. Instead of just dispatching the ambulance, the 911 operator is now empowered to ask some additional questions of the person reporting the accident, leading to more individualized and specialized care.

The HIE infrastructure and data is accessed easily, through a common web browser, but requires a digital certificate for military-grade security. This extra security layer is necessary, due to that fact that access to a patient’s medical information is too sensitive to protect with just simple usernames and passwords. Instead, HIEs (such as the northern Minnesota HIE) are opting to use federal standards (public key infrastructure, or PKI–see the this article for more on security and PKI) to ensure a much higher level of security and encryption.

Once logged into the HIE’s systems, including The Patient Lookup Service (PLS), emergency personnel can look up where medical records exist for the victim. Within seconds of a query, important patient information can be forwarded to the on-board computer in an ambulance, even as it is on route to the victim. Medical information doesn’t come from some centralized system, but instead comes directly from participating hospitals and clinics (no central database required). Armed with the victim’s current medical information, the emergency crew can prepare and check for existing conditions. The PLS system can also retrieve a victim’s current medications, allergies, and similar information to provide dramatically faster and more individualized care to this victim.

Once on-site emergency treatment is complete, and the patient is loaded for transport, the crew can again use their on-board computer to enter their observations and treatments notes, and send this information immediately to the specific emergency room to which they are now heading.

At the emergency room, staff have the current medical information, emergency medical treatment, and other helpful information like emergency contacts and living-will information. Emergency contacts are contacted, and can be at the emergency department within minutes of the patient’s arrival. This is “patient friendly” care, and demonstrates the value an HIE brings to this day-to-day workflow in healthcare.

Can this really work?
Ten years ago building an HIE was hard. Lack of standards for electronic medical documents, proprietary security systems, and expensive software caused many early HIEs to fail. Much has changed recently. Perhaps the biggest advance is the adoption of standardized medical formats for electronic documents, allowing hospitals and clinics to send and receive documents using standardized software. Another advance has been the development of the Nationwide Health Information Network, or NHIN. NHIN allows for the safe and secure exchange of medical information nationally, and has been deployed in selected projects (including the example northern Minnesota HIE).

Effects of Stimulus Monies
Connecting health care and the building of HIEs was already underway when the new stimulus bill passed this February. The stimulus bill created a reward system for clinics and hospitals if they ‘wire up’ internally with electronic health record systems (EHR) AND connect to Health Information Exchanges. With a 30 billion dollar prize being awarded to those who ‘wire up’, expect the pace of EHR and HIE implementations to accelerate quickly.

Conclusion
There is little doubt that new stimulus dollars, combined with NHIN, will help move the US toward a valuable goal; that of an interconnected, secure health care network, including HIEs, to facilitate faster, more accurate, and more efficient patient care.