Concentric Circles of Health Information Exchange (HIE)

HIE Through the Eyes of Provider and Patient

Consultant/Founder at HealthTechture
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While the health information exchange (noun) market continues to develop, providers’ needs for health information exchange (the verb) becomes ever more pervasive and urgent. A dialogue has emerged recently that has separated the HIE market into public and private. However, the way HIE needs to be viewed is through the eyes of the provider and patient – both of whom are at the core of a series of concentric circles, and whom generate data during a visit or an episode of care.

These circles represent various geographic layers indicative of society’s organizational frameworks. The data must flow for multiple purposes at various levels, but the point is it starts from the center of the circle (patients and providers in geographic proximity) and moves to the local, state and national levels.

At the local level, this information (generated by a hospital or provider) is perhaps exchanged within an IDN or hospital system, or among multiple independent hospitals or systems – all of which constitute private HIE. It’s even possible that at this layer of HIE is performed within an accountable care organization. However, care is delivered locally and often not within the same IDN, hospital system or physician group. Therefore, community-based HIE may be necessary to facilitate robust coordination of care across unaffiliated community providers. The state, meanwhile, has a need for health information at an aggregate level for its Medicaid population, and to manage public health concerns. Finally, the federal government needs health information to manage care delivered to Medicare patients, for third-party care delivered to veterans and military beneficiaries, or for federal agency program needs like social security disability determination.

HIEs may be described as private and certainly the organizational structure can be private, but the data is no less unique than information that can be aggregated within a public HIE. And, certainly, where private HIEs are currently flourishing, there is even a greater chance that a public HIE can flourish as well – one that serves the needs of the local community and not just those of private HIE stakeholders.

The important thing to recognize, however, is that there is a core set of data that needs to be compiled in order to be consumed at various stages in the concentric circles. While there are discrete purposes for the data today, there is also a breadth of unknown possibilities, as various organizations begin to compile and act upon this data to further care coordination, population health and public health; as well as reduce costs and increase quality patient outcomes. Just as circles know no end, so too are the possibilities of HIE without limit. It is the effective and interoperable “overlapping” of these shapes that will ultimately transform care delivery and patient health.

Eric J. Klos has more than twenty-plus years of experience demonstrating successful strategic planning, marketing, information technology implementation and management (including web design and development), business development, government policy and public relations in the healthcare IT industry. Most recently he has become an expert in HITECH Act Initiatives, guidelines, and impact on state and local initiatives especially health information exchange within communities and statewide. He can be contacted at: