The efficiency, effectiveness, safety, and cost of patient treatment are all enhanced through electronic health information exchange (HIE), which permits doctors, nurses, pharmacists, and other healthcare professionals to properly obtain and safely share a patient’s vital medical information electronically. The HIE cannot replace the two-way conversation between the doctor and the patient. However, it aids in completing patients’ records through repeated reviews of their medical history and lab data, and sharing vital patient data through HIE benefits patients and doctors when it comes time to make treatment decisions. Medication errors, incorrect diagnoses, and unnecessary tests can all be avoided because of information sharing. Patients often carry their medical records from one doctor’s visit to the next; thus, mail, fax, or hand delivery are only some of how doctors exchange patient information. Provider-patient communication is essential for providing the best care possible to patients. However, electronic health information exchange can significantly improve the comprehensiveness of patient records, which can substantially impact care as patients and doctors review their medical histories, current treatments, and other relevant information together during visits. The study addresses the evolution of the health information exchange system and recommends it to other countries, addressing it in detail and its significance.
Key Words: HIE-Health Information Exchange, WHO-World Health Organization, RHO-Regional Health Information Organization.
Thesis: The paper’s primary objective is to establish a health information system and recommend it to other countries that do not have a fully enhanced health information system by comprehending the benefits of HIE.
Introduction
Along with nationwide initiatives to boost the quality, safety, and efficiency of healthcare delivery, there has been a rise in the need for electronic health information exchange among care professionals. The federal government is providing financial incentives and mandating meaningful use and new payment methods that prioritize care coordination to encourage the sharing of medical records. Clinical data such as test results, current medication, and allergy information may be shared via an HIE. Name, date of birth, and address are all identifying data that could be divulged.
A health information exchange is a centralized database that stores patient information from various local healthcare providers and electronic health record (EHR) systems (Akhlaqet al., 2017, p. 838). The purpose of this standardized, safe system is to offer a care perspective of the patient’s electronic health record. Through Health Information Exchange, doctors and patients can safely and efficiently share and access each other’s medical records online. The many methods of health information sharing currently in use have origins in various settings for providing medical care. The study addresses the basis of health information systems and recommends it to other nations.
Improvement in developing HIE and Current Barriers during Implementation
It is crucial to examine the system and its environment throughout HIE development and implementation to enhance current approaches, instruments, and frameworks. Depending on the context, HIE might be small-scale or global. The idea that health information sharing is fundamental to any viable strategy for improving health care has received considerable attention. The direct access to health information, the decreased time to obtain health information, and the increased knowledge of provider contacts with the health care system are all ways the adoption and usage of HIE technologies have affected patient care. Payne et al. (2019, p. 134) attribute that the timely exchange of a patient’s health records can improve the precision of diagnoses, minimize the number of duplicate tests, prevent hospital readmissions, and eliminate medication errors from the perspectives of providers and patients alike. From the point of view of public health, sharing medical records has led to better working relationships with government health departments, enhanced public health surveillance, and boosted the timeliness and accuracy of public health reporting.
The organizations involved in the HIE need to develop and provide an implementation approach that will make the process very efficient. In implementing HIE in the medical setting, there is a need to train the practitioners and focus on the concept’s specific outcome. Accurate patient data and the free flow of health information bolster care coordination and savings for healthcare providers. Connecting healthcare providers and hospitals are crucial to health information exchange (Akhlaq et al., 2016, p. 1315). Some state and charity HIE networks are more developed and advanced than others, even though the Advancing Interoperability program aids providers in making these connections. HIEs are exploring multiple strategies to increase the number of connected healthcare institutions. Health IT developers are either already operating at the state HIE stage or are in the process of doing so. They are also deploying new and evolving philosophical frameworks and expanding the digital footprint at the state, regional, and national levels.
Improvement for HIE
Several elements, including the nature of the shared data, are essential for healthcare institutions to consider while implementing HIE. Most EHRs allow for the sharing of structured data between medical professionals. However, there is a wide range in the value of data transmitted by EHR alone, particularly between different EHRs. Vest and Kash (2016, p. 80) state that the information obtained is sometimes easily integrated into the patient’s health record. It may be already in the system, but it needs to be formatted to make it straightforward to use or find within the patient’s chart. To ensure that physicians and other vital stakeholders have access to patient information when and where it is required, health information exchange (HIE) aims to facilitate the electronic transfer of patient information between organizations.
Although HIE has been actively pursued at the policy and organizational levels for quite some time, it is still a work in progress. Some information is routinely transmitted electronically, while others are not; some localities have achieved substantial interconnectivity, others have not; some governments have developed HIE legislation, and others are just getting started. As a result, HIE will remain a dynamic field, and it is quickly becoming the top priority of nations that have committed resources to establish national electronic health record infrastructures (Vest & Gamm, 2010, p. 291). Evaluation is essential for showing the value of health information exchange (HIE) in terms of savings, better patient outcomes, and streamlined care delivery. When one evaluates anything, they are trying to figure out how important or valuable it is. A “Regional Health Information Organization” aims to improve health and treatment by facilitating the secure electronic exchange of health-related information across various regional stakeholders, such as healthcare providers, hospitals, smaller clinics, payers, and government organizations.
While there is some variation among Regional Health Information Organizations, they all have a standard set of organizational and technological features that facilitate the electronic exchange of patient data among all parties involved. When patients see more than one doctor, there is a natural demand for clinicians to collaborate and exchange patient data. Many networks may need to offer a method for exchanging electronic health records or other client data. Creating a Health Information Exchange (HIE) is one possible solution; an HIE is a conduit via which doctors, hospitals, and other medical facilities can securely exchange patient data (What is Health Information Exchange (HIE)? 2020). Typically, a Health Information Exchange will be supported by a Regional Health Information Organization (RHIO). To determine what data can be exchanged between members, RHIOs convene multiple parties with vested interests. Before any information is transferred, all parties must sign data use agreements. Getting approval from higher up can require presenting the agreed-upon parameters to the compliance officer. Companies who want to take part must securely store and handle large amounts of digital information. For this reason, RHIOs frequently offer in-house HIT support for healthcare organizations.
Difficulties Faced in Implementing HIE
Because of inefficient and inconsistent methods of creating and storing data, personal health records are not being used to their full potential to facilitate high-quality care delivery. Chen et al. (2019, p. 201) posit that healthcare facilities such as clinics, doctors’ offices, laboratories, and pharmacies maintain their information systems. Due to factors such as shifting insurance policies, patients’ needing to see several doctors, and an uptick in the number of patients requiring specialized care, the healthcare system needs to be more cohesive and able to share information effectively. Changes to the current system of fragmented health information are necessary for various reasons in today’s culture.
Moreover, there are still several hurdles to RHIO involvement and success due to the collaborative nature of HIE. The healthcare industry does not trust its rivals to safeguard its confidential information or refrain from using it to gain an unfair advantage. Feldman et al. (2014, p. 19) address that while skepticism and worries about data ownership are unlikely to bring down an RHIO, they could restrict the types of data that one can share, the types of users who can access the data, and the populations for which data is exchanged. In addition, RHIOs must protect patient privacy even when privacy rules permit sharing of information between institutions for patient care. Finally, the possibility for trade might be harmed by worries about legal liability from the unauthorized publication of information, as this risk must be weighed against any potential advantages.
Lack of adequate standards can raise privacy problems when exchanging digital health information. Therefore, for EHRs to accept and utilize digitally shared information, they must conform to specific criteria. It can be challenging to exchange health information across states due to the difference in privacy legislation and the need for clarity on standards (Health information exchange and RHIOs – RHIhub networks and coalitions toolkit, n.d.). In addition, medical professionals need help meeting federal regulations when transferring patient records with their counterparts in another state. Covering the price of health information exchange can be challenging because it involves several different expenses, such as the price of purchasing and implementing an HIE system, the price of joining a local or state HIE organization, and the cost of transaction fees for exchanging information between vendors.
Establishing an interface for health information exchange can also incur unexpected costs. In addition, some HIEs include merely a summary page that doubles as a continuity of care document. The generic character of the record is that it may lack specifics about the patient’s health that are vital for administering the appropriate care. Health Information Exchange summary (2017) states that one of the main obstacles in health information sharing is getting patients’ permission to share their medical records across different digital and healthcare networks. Transferring a patient’s health records without their consent also carries the potential for legal repercussions. Because of this, there is great rivalry between HIE service providers. Competition between institutions on patient acquisition and data exchange is expected to persist. As a result, providers’ reluctance to share patient data has slowed the growth of health information exchanges.
Endorsing HIE to other Countries and its Benefits
Electronic medical record platforms or other devices to acquire clinical information at the point of collection and at the recipient entities, coupled with secure systems over which the data is sent, are necessary components of the technical infrastructure needed for HIE. Even among countries with highly digital health systems, there is a broad range in HIE infrastructure availability and scale, as well as HIE process maturity. If medical records are not available in electronic format, the clinical value of health information exchange will be diminished (Lin & Chang, 2018, p. 776)). While some nations have already implemented digitalized, interoperable patient data, in others, using the accessible HIE technology for transmitting clinical information requires forms to be printed, digitized, and transferred, which reduces their utility for secondary data analysis and incorporation with other information systems.
Several nations have already implemented or are incorporating Personal Health Records that increase patient access, choice, and prospects to engage supplementary data from health devices or apps, signaling a shift toward a greater focus on the patient as a central player in the HIE ecosystem. As it is now practiced in China, the UK, India, Scotland, Switzerland, and the USA, HIE is described concerning two scenarios: transition of care and referral (Zozus et al., 2019, p. 527). The documents represent each country’s goals, challenges, and plans for expanding clinical information exchange. Each country has its EHR adoption rate, health data in an electronic format suited for HIE, and IT infrastructure for transmission. In India, people can choose between extraordinarily primitive and highly sophisticated medical facilities.
By bridging the gap between health records and services, HIE infrastructure can bolster publicly funded healthcare systems while fostering the expansion and transparency of the commercial insurance-based healthcare sector. In Switzerland, the Integrating Healthcare Enterprise cross-community access guidelines are used to develop a standard patient record for primary care. Every service provider should join at least one group. The federal government grants certifications to communities. Vest and Gamm (2010, p. 290) assert that all patient records, regardless of which community stored them, are available to them through any community portal. However, recurring themes surfaced, such as the hope that data will be shared rather than collected once again, the importance of financial incentives to encourage data sharing, and the necessity to protect sensitive patient information.
The Future of HIE in Various Countries
Some have proposed that health information exchange (HIE), the electronic transfer of patient-level data between institutions, is the answer to the problem of data fragmentation in the healthcare industry. The 2030 Agenda for Sustainable Development emphasizes the potential of increased global connectivity and the dissemination of information and communications technologies to hasten the development of knowledge societies, close the digital divide, and speed up human progress. To better provide public health and health services in an integrated fashion, Member States are actively constructing upon their national frameworks for eHealth through reform measures in the health domain and health information systems (Adler-Milstein & Dixon, 2016, p. 253). They recognize the need for federal priorities, initiatives, and regulations to enable the advancement and long-term feasibility of investments in eHealth and its role in realizing universal health coverage. However, a more unified strategy for planning, executing, and assessing the impact of eHealth as a national strategic asset is required. True HIE is still relatively uncommon. Despite this, many countries see HIE’s potential benefits, spawning national and international projects with varying focus, scale, and breadth levels.
National efforts have built architectural approaches, monitoring agencies, and mechanisms to stimulate exchange while still working to tackle the difficulties of interoperability, record linkage, inadequate infrastructures, management, and inter-organizational connections. HIE will stay on many national platforms due to its ability to address numerous cost and quality challenges (Lin & Chang, 2018, p. 773). Executives and leaders in the healthcare industry often have the chance to collaborate with national initiatives to influence the direction of local exchange administration and the selection of technology partners. The opportunity to get health data where it is needed most is frequently cited as a positive aspect of HIE adoption. Still, the degree to which this has been realized varies considerably among the scenarios considered in this analysis. Nonetheless, these distinctions show that the countries mentioned are at different points along a comparable road. These have been overcome to varying degrees, depending on the situation.
Benefits of HIE
Primary care doctors, specialists, and ER doctors can all benefit from digital health information systems since they can access identical, up-to-date patient records. Errors may be costly and harmful, so preventing them is a great way to save money and enhance patient safety. If this approach can save just one life, it will have more than paid for itself. Additionally, HIE improves the effectiveness of healthcare as a whole. Data sharing reduces the need for patients to repeatedly supply the same information to their new doctors or specialists. It also allows them to better prepare for their appointments (Health information exchange (HIE), 2021). As a result, the doctor or nurse will have more time to spend with the patient and less time on administrative tasks. One can also use this method to send reminders and follow-up instructions to the customer directly. Delivering prescriptions and medical supply orders straight to a pharmacy or surgical supply business expedites the pre-authorization process and the shipping of such products.
HIE optimizes patient care, reducing the possibility of duplicate interventions since everything is more precisely documented. Other advantages include providing a method for healthcare providers to increase the quality and safety of patient care as errors are reduced. Making things more transparent for patients and doctors also creates a feedback mechanism between health-related studies and operations. Mistakes can be minimized using EHRs because they keep all parties informed about a patient’s status. The idea is that everyone involved in a patient’s care has access to the same data, allowing them to work together for the best possible outcome. Through HIE, patients can be provided automatic appointment reminders or follow-up instructions, and their prescriptions can be routed to the required pharmacies (Adler-Milstein & Dixon, 2016, p. 257). HIE emphasizes spending less time digging through documentation and more time enabling patients to dialogue with their healthcare professionals about their health and the required treatments.
HIE facilitates seamless integration with an organization’s or provider’s existing electronic health records (EHRs). In particular, it enables the secure and efficient movement of health information in electronic form between parties using diverse technologies, with no extra knowledge or effort required on the side of the sender or the recipient. Mamuye et al. (2022) attribute that to ensure that all of a patient’s information is consistently incorporated into each clinic’s EHR, HIE employs data standardization techniques. The EHR shows the same crucial patient data, no matter which input the report. It paves the way for accumulating a wealthier resource of patient-specific health data. For instance, if a doctor obtains aberrant laboratory test results, they can be flagged in the patient’s electronic chart, allowing for more efficient scheduling of follow-up appointments, specialist consultations, and more lab tests to meet the patient’s needs better. More medical professionals are joining health information exchanges to more accurately record and securely communicate patients’ medical histories.
HIE aids in the delivery of coordinated patient care, the elimination of unnecessary procedures, and the prevention of wasteful errors. The benefits of HIE are substantial, and the necessity for HIE is evident; thus, more and more healthcare providers are adopting this approach. By providing the same data to general care doctors, specialists, and emergency room staff, EHRs can reduce the likelihood of medical mistakes. HIE also promotes effective care by facilitating the direct transmission of prescriptions to pharmacies and the automatic dispatch of appointment reminders or follow-up instructions to patients (De Pietro & Francetic, 2018, p. 71). HIE shortens the time spent by patients and doctors on administrative tasks like filling out forms and briefing one other on health histories, freeing up more time for open dialogue about medical issues and possible solutions. HIE has the potential to cut costs and enhance health outcomes by reducing time for patients and clinicians across the whole continuum of care.
Conclusion
While facilitating secondary utilizes of data for research and data visualization is an essential motivation for HIE’s development, improving health care quality and outcomes directly through the availability of up-to-date patient information at the point of care is the primary reason for its widespread adoption. The growth, use, and administration of HIE will undoubtedly be influenced by the structural, societal, financial, and political factors that distinguish health systems worldwide. Health information exchange (HIE) is gaining interest from healthcare organizations as they realize its importance in improving clinical workflows and patient outcomes. Therefore, it would be beneficial to integrate international HIE initiatives around a general platform, such as the UN Sustainability Goals. However, political will and the deployment of appropriate incentives are crucial to accomplishing these goals.
Rather than replacing the need for open lines of communication between doctors and their patients, HIE improves the quality and consistency of medical records. Such reassurances are crucial, and in today’s healthcare system, where patients often see numerous doctors and experts, they can mean the difference between life and death. New perspectives on provider payment that emphasize care coordination, meaningful use requirements for utilizing certified EHR technology, and financial bonuses from the federal government are all factors that are encouraging more and more providers and procedures to investigate and implement HIE. The necessary technology, standards, and policy are already in place to implement the HIE in any form, and many U.S. medical facilities are now doing it.
Many health information exchanges (HIEs) exist today, created by various governmental and non-profit organizations on a local, regional, and state level. Numerous electronic health record (EHR) providers and national health networks have already included HIE in their operations, and accountable-care entities are sprouting up around the country to push local HIE models. As a result, sharing health records is becoming an increasingly vital component of 21st-century medical practice. There is optimism that healthcare can become more simplified, safer, and less expensive as this digital health format becomes more widespread. In addition, the current evidence base on the effects and value of HIE for various stakeholders needs to be strengthened by more research and continuing evaluation.
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