Born in a Manger: The Birth, Adolescence and Future Rise of Health Information Exchange

By Buff Colchagoff, CEO, RosettaHealth
Twitter: @rosettahealth
Twitter: @BuffColchagoff

’Tis the time of year when nativity scenes make their annual appearances around neighborhoods and churches. As we celebrate birth in this season, I want to reflect on the HIT sector and the birth of modern health information exchange – both the verb and the proper noun.

Of course, facility-to-facility exchanges have existed for decades, but the real birth of HIEs (noun), as well as regional and national networks has been much more recent.

As with the Christian nativity, health information exchange (verb) arrived on a special occasion, with wise men bearing gifts in the form of the stimulus package of the HITECH Act.

In this metaphor, the wise men and women at the Office of the National Coordinator for Health Information Technology (ONC) brought gold in the form of $2 billion in funding for EHRs, HIEs, and Regional Extension Centers (RECs). These tidings of joy brought about the ability to truly exchange medical records.

In looking back, it’s hard to remember how low electronic record usage was pre-HITECH. But the gift of this legislation truly brought forth a bounty of electronic records to the land.

During those early HITECH days, the promise of affecting care outcomes by using electronic records, interoperability and exchange was palpable – where HIEs and RECs sang songs of joy for this new era. Fast-forward to today, and many may not see this promise as being fully realized.

While there has been great progress in certain areas such as the emergence of national networks (i.e., eHealth Exchange, Carequality, and CommonWell Health Alliance), other areas have not blossomed.

For example, HIEs have experienced mixed results. Some HIEs are thriving with rich data sharing capabilities, while some from the early HITECH days are no longer operating. Many are still trying to provide wide-area comprehensive sets of services. Unfortunately, in some camps the term “HIE” is passé and provincial, where the shiny new QHINs are emerging as the real deal.

Whether it’s an old school HIE, or a new-fangled QHIN, the overall intent is the same, which is to enable the flow of electronic records amongst all communities to provide better care outcomes.

I believe health information exchange is going through its adolescent phase currently. The promise of it is starting to show, but there is still the acne and awkwardness that is common with teenagers.

Just as with any birth, there is a period of nurturing and growth before the progeny is useful. Health information exchange may not be dominating the news cycle, but wonderful things are coming in the near future.

As the COVID-19 pandemic has shown us, investments in infrastructure for public and population health offer immense dividends. That alone is reason for investment and hope. But the capabilities and coverage of health information exchange is growing with new and innovative use cases emerging beyond the basic pushing of records and query-retrieve.

Here are a couple of examples of higher-value use cases that require capabilities and coordination beyond just individual point protocols:

  • PCDH – Enables local and regional networks to interconnect efficiently and accurately. In the PCDH model, data is only shared when a patient moves between systems covered by different nodes. There is no global query or push, rather a federated record locator service based on the patient’s home. Identifiers are exchanged in the PCDH model between a hierarchy of HIEs so that each record is run through the MPI of the receiving system and allows for reconciliation and integration into the patient longitudinal record, resulting in better patient matching than can be achieved with a simple demographic patient discovery query.
  • Image Pre-Fetch – Many image studies require a prior or are enhanced by reviewing priors – for example mammograms. Collecting priors across a geographic area manually is time consuming and rarely done. A pilot effort with an HIE using an automated rules-based retrieval of priors when studies are scheduled makes priors easily available before their appointment. An HIE can do this because it the wide area and comprehensive data set. The radiologist has all relevant images when they see their patient resulting in better studies and reduced duplicate procedures.

These are but two examples of the emerging higher-value use cases that modern exchanges are facilitating. In this time of celebrating the birth of new eras, the miracle of health data exchange is finally upon us.

With the infrastructure and supporting organizations working hard to get us past the adolescent phase, the promise of ubiquitous data exchange will soon live up to its best potential and have a true impact on care outcomes.