What the H(I)ELL is HIE?

Sorry for the terrible wordplay but I just couldn't resist. There's been a whole lotta talk about HIE lately so here's a brief overview of what it's all about. The HIE is one arm of the ONC's larger strategy to transform health care quality and safety through improved information sharing.

The first arm's aim is to lower "commercial" barriers that prevent exchanges of information between patients, providers, and institutions. Often times these barriers are due to competing commercial demands of providers, i.e. "the patient data is mine". The government is hoping to develop a new marketplace on a state-by-state basis that encourages "co-opetition" (getting competing entities to share essential info) to develop standards that small practices and large health care organizations, AND patients can abide by.

The second aim has to do with providing "economic" incentives around adoption of EHRs. This arm of the HITECH Act contains the "meaningful use" provision and is getting getting much of the press. For clinical information to be shared requires capturing the clinical data in the first place. EHRs are the interface between the clinician/patient and the HIE.

The third arm of the HITECH Act deals with "interoperability" and encouraging standards around compatible technologies and policies. Of utmost concern to many is that patient data is transported "securely, privately, and accurately" as it flows across the wires.

That's real high-level stuff, because the work that fits in between the arms is how to make it all work on the ground. For example, clinical decision support (CDS) is the driver that informs provider and patient decision making and behavior change. However, the jury is still out on which model of CDS works most effectively. Also, only 4% of community practices currently have CDS and very little research has been within these settings. Effectively integrating CDS and other knowledge resources into clinical workflow is critical for EHR adoption and will take a lot of effort and creativity to do it right. There will definitely be lots of opportunities for exciting work!