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Health Information Exchange

HealthInformation Exchange

Tableof Contents

Health Information Exchange 2

U.S. History of HIE 4

Benefits of HIE 5

Current Challenges Facing HIE 7

Ways to Address the Challenges 9

List dilemmas 9

Conclusion 11

References 12

HealthInformation Exchange

Healthinformation exchange (HIE) refers to mobilization of health careinformation through electronic means to allow doctors, nurses,pharmacists, and health practitioner access, and secure patients’vital medical information. Practically, health information exchangerefers to an institution that facilitates data exchange (Health IT,n.d ). It facilitates sharing of clinical information among differentorganizations via electronic means. The main objective of HIE is toprovide the right to use and recovery of medical data with the aim ofgiving efficient and effective patient-centered care. While onlineHIE cannot substitute practitioner-patient communication, it canenhance the process of recording keeping in health facilities.Additionally, the timely sharing of clinical information amongdoctors, pharmacists, and nurses helps with decision making allowingthem to avoid re-admissions, improve diagnoses, avoid medical errorsand minimize duplicate testing (Health IT,n.d).

Furthermore,HIE is an important element of the NHIT (National Health InformationTechnology) infrastructure being developed by the HITECH Act. Healthcaregivers, as well as policymakers, believe that it will producehuge benefits in the public health sector. For health care providersto use this system, they must electronic health record system thatuses either Stability of Care Record or Document (Steciw, 2011).Additionally, nationally acknowledged standards are important toensure that the information is well formatted and secured. This alsohelps in making sure that systems containing health information cancoordinate with each other properly. Notably, the standards for HIEare set by the U.S. Department of Health and Human services.Nonetheless, the ONC is the principal agency in charge ofrecommending the standards. This paper will analyse the history,challenges, and implication related to health information system inthe United States.

U.S.History of HIE

HealthInformation Exchange began over 20 years ago in the United States.The efforts started through the foundation of Community HealthManagement information, whose main purpose was to create acentralized data repository to be used by seven communities fromdifferent geographical locations. Initially, the community facednumerous challenges such assecuringthe stakeholder trust, lack of strong political support andcost-effective technology. In the year 1990, a comparable programregarded as Community Health Information Networks was designed withthe goal of sharing medical information (Dullabh, Moiduddin, Nye, &ampVirost, 2011). Nonetheless, the program did not meet its main agendawholly. Later in the year 1999, the Institute of Medicine Reportconcluded that medical blunders were major threats to Americanshealth. Consequently, new methods to address such issues emerged,whereby it was found out that information technology was the bestoption. In 2004, National Coordinator of HIE office was createdduring the administration of George W. Bush the then U.S. president.Additionally, AHRQ (Agency for Healthcare Quality and Research)financed 166 million dollars in pacts and endowments to enhancehealthcare policymaking, improve safety and quality, and supportpatient-oriented care. The funding also included a program thatsupported both local and regional level of health informationexchange. Further, the AHRQ arranged for 5 million dollars to sixstates, which included Rhode Island, Utah, Delaware, Indiana,Tennessee, and Colorado.

Moreover,the State and Regional pilot study project extended informationexchange to large geographical locations and produced the greatestpractices for emerging governance and policies. Additionally, theproject created both technical and trust solutions for all thestakeholders. The Medicare Modernization Act authorized the AHRQ toaward 6 million dollars to five states to assess the morals inelectronic prescribing. The tests were meant to assess how efficientprescriptions were transmitted electronically. Besides thegovernment sponsored initiatives, HIE was established in variousacademic and market settings.

Theterm health information exchange has been changing from time to timefollowing definitions are given by various experts. For instance,after the National Coordinator Office was established in the year2004, the two terminologies, Regional Health Information Organizationand could be used to describecomplimentary. Later in the year 2008, AHIT (Association for HealthInformation Technology) provided some other descriptions of keyhealth IT terminologies. HIE was defined as the process of exchanginghealth data while RHIO was described as a regional organizationexchange data.

Benefitsof HIE(underlying the justification for HIE)

Justlike in any other industry, the capacity to share information byelectronic means comes with some benefits. Improved care due toreduced medical errors is one of the main benefits that areassociated with the program. Accessibility of information in everydepartment within a healthcare facility gives a health provider, acomplete and a better picture of the health of the patient. In otherwords, the physicians or the medical provider can ensure that themedications or the treatment do not interact poorly with othertreatment. For instance, when the patient is not sure about the kindof medication he or she is receiving, it is considerably easy toaccess the medical history through the health information exchange.Eventually, this tool reduces chances of conducting medical errors,and as a result, good medical care is assured.

Trackingis also easy through HIE. When information is exchanged through theHIE, information on when the patient data was accessed, who retrievedthe data, date of access, the type of data that was retrieved, andthe reason for information access is tracked. Fundamentally, thismeans that it is easier to establish laws and regulations that governaccess when using electronic information.

Thesecurity of patient information is also enhanced through Healthinformation Exchange. In the traditional way of storing patient’sinformation, it is hard to retrieve information in case of disastersand emergency errors. Accordingly, this means that it wasconsiderably hard to know when the patient was admitted, what thepatient is being diagnosed with, and how far the physician has goneas far as the treatment of the patient is concerned. In other words,after a disaster, the patient can only be diagnosed by trial anderror method or by relying on the patient who may not be aware oftheir medical progress. Eventually, this may deteriorate the healthof the patient. In practice, disasters and other forms of emergenciesoften cause significant loss. This includes loss of information,destruction of properties, deaths, disabilities, injuries, andpsychological problems among others. With HIE, it is easy to get thepatient’s information as it is usually stored in a distributednetwork. Therefore, it is easy to diagnose the patient with thecorrect and accurate information.

HIEhas also played a critical role when attending patients inemergencies. In practice, it is not easy to prepare for accidents. Inan emergency, most patients are not able to explain their healthhistory to physicians. In such situations, Health InformationExchange plays a significant role in providing such information tothe health provider. The medical provider van easily get informationregarding historical health issues, historical medications, and moreimportantly historical tests to make an informed decision about theemergency. For instance, it is easy to know the blood group of thepatient in a situation where a blood transfusion is required. Inother words, it is easy to diagnose such a patient from historicalinformation.

HIEreduces duplication in health care. Traditionally, it was normal forthe medical providers to ask some questions before attending to thepatient. For instance, family background issues regarding thecondition, historical information about the condition, among others.Besides, it was also procedural for physicians to conduct varioustests such as blood tests. Such procedures are sometimestime-consuming and unnecessary. HIE, stores such information makingit easy for the medical providers to see historical tests and resultsof the patient. For instance, it is important to avoid more X-raytests as it protects the patient from radiation risks as well asother side effects.Besides, it also reduces the patient’sfinancial burden as they are required to pay less for the varioustests that are conducted.

CurrentChallenges Facing HIE

Justas in any other industry, every beneficial program has somechallenges The ability of toelectronically exchange data is associated with various risks andchallenges. Medical identity theft is one of the main challenges thatare facing electronic exchange of a patient’s information.Fundamentally, medical identity theft is a situation whereby someonefraudulently acquires another person’s information including thehealth insurance number, name, social security number to obtainmedical services. Although identity stealing happens with bothelectronic file and paper files, a breach in an electronic file mayaffect more records than a paper file. In a survey that was conductedby Theft Resource Counter, medical-related identity theft wasapproximated to be 43 percent in 2013 (Stateline, 2014). In such asituation, victims of identity they often experience erroneousinformation or financial repercussions which are not only challengingto them but also the medical healthcare.

Hackingis also another big challenge to the HIE. Essentially, data that isaccessed from financial institutions such as banks become almostuseless after the discovery of the breach and after the passcodeshave been changed. Nevertheless, data that are acquired fromhealthcare, including medical histories and personal identities canforever be useful. According to the industry consultancy Accenture,it is projected that in the next five years, cyber-attacks will costhealth care centers approximately $350 billion (Mearian, 2016). It isalso projected that one out of thirteen patients will have theirinformation compromised by hackers. One of the main reasons for thisprojection is because healthcare centers are uniquely vulnerable tosecurity breaches because of various things, including HIE, EHR(Electronic Health Records), as well as other advances in theObamacare. Besides, health records contain other valuableinformation, including home addresses, patient’s health histories,and social security numbers, among others making them more prone tohacker’s attacks. According to various researchers, hackers usethis patient’s data to sell at a premium on the black market.

Errorshave also proved to be a critical challenge. The law providesprovision for medical practitioners to correct errors they find inpatients medical records. Those corrections are commonly referred toas amendments. Typically, medical chronicles are transferred frompaper files to digital files. During the transfer, there is alwaysroom for mistakes. Nevertheless, the review and the correction isapparently warranted. In practice, HIE is meant to improve healthcare by improving the accuracy of the information that is used tomake decisions regarding the health of the patient (Torrey, 2016).Just like in any other system, if the information entered into thesystem is wrong, the various departments use it until it iscorrected. Such information can be misleading, and the patient canreceive wrong medications or treatment from such an error.

Additionally,sustainability is also a critical challenge. Fundamentally, thesustainability models of the remain inthe embryonic stages across states. For this reason, economicsustainability is a key concern. For instance, it is unclear whetherproviders will be willing to pay for state-sponsored programs. Inaddition, it is not clear whether these services will be available atthe end.

Competitionby healthcare operators poses a great challenge to HIE. In spite ofthe various efforts that are made in government regulations andtechnology to develop an effective HIE, competition between slowscooperation (Vest &amp Gamm, 2010). Until the government comes upwith a long lasting solution, organizations will continue competingfor patients.

Waysto Address the Challenges

Theeffort to determine the various challenges of the free flow ofelectronic health information while maintaining the security and theprivacy are currently in progress at various state levels. Assessingdiscrepancies in organizational level business policy and state lawsthat affect HIE is considerably critical (Staff, 2011). It is alsoimportant to develop a detailed plan to implement solutions. Theeffective use of legislation is one of the most effective ways toaddress HIE challenges, especially on matters that relate to securityof data. Although most states in the US have passed legislation tostrengthen security and privacy of health information, more need tobe done (NORC, 2014). It is critical for the government to usebroader health reform legislation to bolster Health InformationExchange. Additionally, effective use of non-legislative policylevers is also another practical way of dealing with HIE challenges.Some of these levers include setting favorable procurement rules,establishing incentives and more importantly offering sub-grantprograms.


Despitethe many advantages that HIE has brought to the health sector, it iscurrently faced with many dilemmas. The current dilemmas thatthreaten the adoption of HIE include ethical, legal and financialdilemmas. The legal system which depends on the precedent of thenewest innovation, including HIE, offers little or no guidance tohelp in the shift from paper to electronic records (Sittig &ampSingh, 2011). The increased pressure to develop local, national, andstate HIE will require health practitioners to have rapid access tomany organizations’ papers-based chart (Sittig &amp Singh, 2011).Despite the fact that these initiatives solve long-term issuesrelating to missing clinical data, there is a precedent thataddresses the degree for which the clinicians are accountable foranalyzing data in a community –wide unified HIE. Therefore, itbecomes difficult for health care providers to examine the entirerecord with a reasonable period.

Also,the enhanced accessibility and portability of HIE data raises ethicaldilemmas pertaining the rights of protected health information. Otherethical questions raised regarding HIE is the providers’ ability toavert and notify clients of the possible risks for confidentialitybreach (Sittig &amp Singh, 2011). Notably, some patients worry aboutthe increased risk of unauthorized disclosure of medical informationthrough HIE. In some instances, their worries might be valid.Recently, there have been several cases of HIE vendors who sellbranded copies of their client`s records to medical device makers,pharmaceutical firms, and health researchers. As a result, severalgroups that fight for patients’ right have advocated “opt-out”right that requires a patient’s health data not to be stored inelectronic health records. Further, the execution of HIE willcertainly produce information to rationalize and redesign thecountry’s health care payment and delivery mechanism increasingethical dilemmas.

Thefinancial dilemma is another aspect surrounding health informationexchange. The major question is who should pay for the HIEs. Thepresent provider reimbursement programs indicate that approximately90% of the financial gains from HIE goes to the health care playersinstead of those who fund the executions. Further, another financialdilemma arises due to longer record maintenance requirements (Sittig&amp Singh, 2011).


AlthoughHIE has a considerable number of benefits, it is prudent not tooverlook on the various challenges that are associated with the tool.To get the maximum benefit of the tool, it is important to addressthe various challenges, especially regarding the security and theprivacy of a patient’s records. Nevertheless, HIE has played anintegral part in promoting healthcare by addressing the fragmentationof health information. The tool has also frolicked a chief role inenhancing accuracy and reliability of a patient’s data, while atthe same time, reducing their costs.


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NORC.(2014). KeyChallenges to enabling health information exchange and how states canhelp.Chicago: University of Chicago.

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Stateline,M. O. (2014, February). The rise of medical identity theft inhealthcare. KaiserHealth News:Retrieved from: http://khn.orgnews/rise-of-indentity-theft/

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Vest,J. R., &amp Gamm, L. D. (2010). Health information exchange:persistent challenges and new strategies. JAm Med Inform Assoc.,288–294.