Although medical professionals may have been using the phrase "health information exchange" for centuries, the health information sharing organizational arrangement used today was first mentioned in the popular media by the Canadian Press in 1977, according to Google's archives, when Canadian health officials agreed to set up an inter-provincial HIE for studying coronary bypass surgeries and occupational health trends.
Now, pretty much worldwide, HIE is a noun, verb, organization and process, and an integral part of modern medicine. In 2012, in the U.S. and elsewhere, dozens of HIEs and HIE technologies blossomed, with health organizations making advances in population health management, biomedical research and transparency, insurers buying HIEs amid accountable care programs and health information networks serving as a key public utility in times of natural disaster.
[Related: HIE and the patient privacy conundrum]
When Hurricane Sandy was flooding large swaths of New York City in late October, the Statewide Health Information Network of New York (SHIN-NY) was functioning more or less undisturbed, fostering a smooth continuity of care at hospitals receiving patients evacuated from Manhattan. "We're not having to do anything boots-on-the-street explicit," SHIN-NY executive director David Whitlinger said at the time. "That's the power of the virtual network. For the most part this just happens naturally… as part of the course of the network that's in place."
Just as the new risks posed by extreme weather events have been leading some engineers to consider new infrastructure designs more resilient to the 100-year storms, officials at the Office of the National Coordinator are hoping healthcare systems and state governments can put together HIE contingency plans in the event of large-scale evacuations, like those seen in the South after Hurricane Katrina and in New Jersey and New York after Sandy.
The ONC is urging Gulf states, especially, to have disaster HIE frameworks; the agency recently published a legal, IT and governance guide to coordinating health information sharing in the wake of natural disasters. The goal is that someone from Biloxi, Mississippi, evacuated to Mobile, Alabama, would be able to have his or her health records accessed by providers in the need of emergency care out of network.
Ensuring that that becomes the norm in healthcare has required significant investment in data storage and exchange software, as well as collaboration between provider computer systems. Health record mobility and ease-of-access is one major goal for the ONC, and so is spurring interoperability — linking multiple organizations across software platforms.
HIEs and electronic health records have largely co-evolved over the past decade, and some of the most robust HIEs, like Indiana's, predate the Meaningful Use program. The Regenstrief Institute and BioCrossroads, both based in Indianapolis, formed the Indiana Health Information Exchange along with hospitals and the state health department in 2004, as Indiana saw rising rates of obesity, diabetes, heart disease and other chronic conditions, along with rising healthcare costs, much as the country has seen as a whole.
With the vision of enabling information to follow patients, and to put the information to productive use, the Indiana HIE grew to include 90 providers and 10 million patients, which is all of Indiana and another 3.5 million-some residents of neighboring states.
Providing EHR and exchange solutions and services to providers and physicians, IHIE has found a business model that in turn supports its public interest efforts. IHIE is the IT facilitator for the 2.7 million patient Beacon Community in central Indiana, which has so far made progress in improving diabetes and cholesterol management and increasing certain cancer screenings. The HIE also operates a public reporting website showing clinical quality assessments for about 750 physicians across the state – something healthcare transparency advocates say is a huge boon for patients, employers and the greater healthcare market.
If interoperability is one pressing challenge that’s recently come to the forefront, financial sustainability has probably been the major challenge all along. Recently the D.C. Regional Health Information Organization shut down operations after problems finding long-term funding arrangements with area providers. When it launched in 2008, the D.C. RHIO was one of the first HIEs in the U.S. to include a central data server that allowed the exchange of medication and imaging records. For now, the D.C. healthcare finance agency is offering a direct secure messaging system.
The great promise of HIEs in the coming future includes clinical analytics and population health management, both potentially bringing more scientific understandings of treatments and models that work in modern healthcare. William Reiter, MD, the CMIO of the HIE HealthShare Montana, who practices at Anaconda Internal Medicine, is one of the upper Rocky Mountain region’s health IT evangelists, and he's spent the past few years encouraging Montana doctors to attest for Meaningful Use and sign up for the HIE.
"When we have presentations around the state," Reiter told Government Health IT in September, "the first part is always about the HIE, and everyone in the audience is half-asleep. They're fast asleep when you drone on about Meaningful Use and the criteria that they have to meet — because they consider that more of an administrative rather than a physician thing. When we start talking about analytics, and when we pull up i2b2 and the docs see what they can do with it and how they can interrogate their own data, it's almost like literally the audience goes wild.”
Reiter was talking about the health informatics software i2b2, an open source code set that's led to plug-ins and spin-off platforms like the web-based query and California data sharing network SHRINE. HealthShare Montana is planning to use i2b2 as the basis for a statewide clinical repository, with patient data set to start coming into the HIE in late 2012.