Health Information Exchanges (HIEs) and Your Practice

HIMSS defines Health Information Exchange (HIE) as “an electronic movement of health-related information among organizations utilizing nationally recognized standards and policies.” Organizations include hospitals, diagnostic facilities, and medical practices.

Healthcare delivery is all about information exchange and could not take place without the ability to transmit referral requests, prescription renewals, lab reports, and hundreds of other pieces of medical information using some mechanism. In the current, dominantly paper-based, healthcare system, information flows in many ways including fax, mail, hand-delivery, telephone, etc. When fully implemented, a Health Information Exchange (noun) enables many of these processes to take place electronically using data standards such as ICD-9, ICD-10, SNOMED CT, and LOINC and messaging standards such as HL-7. This means that when a message is transmitted electronically from one system to another, it is sent using a format that is understandable so that it can be translated by the receiving system into exactly what was intended by the sending system.

The wide range of facilities and clinical providers create an extremely complex setting. If each medical practice had to individually manage the accurate transmission and receipt of hundreds or thousands of messages each day, a system such as an EHR would require hundreds of interfaces to other systems. This point-to-point transmission of information is possible in a small network of sites; however, maintaining interfaces becomes problematic when upgrades take place and the risk of transmitting inaccurate data increases with a rising number of interfaces.

Health Information Exchanges take over this critical role by acting as an intermediary. Instead of each individual clinical system maintaining specially designed interfaces, as long as they use a standards-based message format, information can be widely transmitted from one location to another using the HIE. Common types of data exchanged include lab results and prescriptions, and clinical notes between inpatient and outpatient settings.

Many clinicians may not even be aware if their EHR uses a Health Information Exchange. This is understandable and quite appropriate. In order to operate a motor vehicle, you do not need to know how the power gets from the engine to the wheels. Similarly with EHRs, it is not necessary to know how information flows from one point to another. One needs to have the reassurance that if you order a lab test, it will be sent to the correct location and in the right format with 100% accuracy. Depending on the type of care delivered and the location of a medical practice, an EHR may transmit and receive information with more than one health information exchange. As long as the data and messaging standards are consistent, it should not make any difference.

Information can also be exchanged uni-directionally or bi-directionally. This is important to practices when selecting an EHR. For example, while it may be possible to receive laboratory results, it may not be possible to submit a lab requisition. This is an example of a uni-directional exchange of information. Although bi-directional information exchange is desirable, the inability to transmit a message in both directions could be a result of a deficiency in the clinical system (EHR) or the Health Information Exchange. Therefore, ask your prospective or current EHR vendor which data can be transmitted bi-directionally and if only uni-directional at this time, when they expect to be able to transmit information in both directions.

If you were involved in the selection of your EHR system or are tech savvy, you may know which HIE(s) your EHR uses. If you practice in a certain geographic location, you may have no choice but to use a specific HIE. Many of these Health Information Exchanges have been funded through state or federal grants and use commercial software that they purchase and maintain. One of the few reasons to be aware of which HIE your EHR uses is the unlikely event that the HIE could cease due to bankruptcy or funding restrictions. If you hear that your HIE may be going out of business, contact your EHR vendor immediately and find out what their plan is to keep information flowing smoothly.


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