Chapter 15: Health Information Exchange
Hybrid model
A cross between the centralized and the decentralized models of health information exchange, which combines the functionality of a record locator service and a centralized data repository.
eHealth Exchange
A group of federal agencies and non-federal organizations that came together under a common mission and purpose to improve patient care, streamline disability benefit claims, and improve public health reporting through secure, trusted, and interoperable health information exchange. Participating organizations mutually agree to support a common set of standards and specifications that enable the establishment of a secure, trusted, and interoperable connection among all participating Exchange organizations for the standardized flow of information.
Trust community
A group of organizations that have identified a set of mutual goals and dependencies that through collaborative effort lead to mutual benefit.
Data Use and Reciprocal Support Agreement (DURSA)
A legally binding contract that draws from federal and local laws and defines the requirements for participation in the eHealth Exchange national network.
Master Patient Index (MPI)
A patient-identifying directory referencing all patients related to an organization and which also serves as a link to the patient record or information, facilitates patient identification, and assists in maintaining a longitudinal patient record from birth to death.
Clinical Document Architecture (CDA)
An HL7 XML-based document markup standard for the electronic exchange model for clinical documents (such as discharge summaries and progress notes). The implementation guide contains a library of CDA templates, incorporating and harmonizing previous efforts from HL7, Integrating the Healthcare Enterprise (IHE), and Health Information Technology Standards Panel (HITSP). It includes all required CDA templates for Stage I Meaningful Use, and HITECH final rule.
Nationwide Health Information Network (NHIN)
Established by the ONC in 2004, it was initiated to create a governance, standards, and policy structure that could be easily adopted and scaled to enable health information exchange across organizational, regional and state boundaries; it is a set of guidelines, recommended technology standards, and data use and service level agreements that can facilitate data exchange.
True
Health information exchange (HIE) is possible without large expenditures on health information technology.
False
Health information exchange (HIE) is the ability to request healthcare information from a centralized database.
Healthcare information is available where and when it is needed.
How is health information exchange intended to improve quality of care?
Continuity of Care Document (CCD)
The result of ASTM's Continuity of Care Record standard content being represented and mapped into the HL7's Clinical Document Architecture specifications to enable transmission of referral information between providers; also frequently adopted for personal health records.
Query-based exchange
Used by providers to search and discover accessible clinical sources on a patient; a query on a database asks a question of the database and pulls information based on the keywords that are used in the query; this type of exchange is often used when delivering unplanned care such as ED visits.
Health Information Technology for Economic and Clinical Health (HITECH) Act
created to promote the adoption and meaningful use of health information technology in the United States. provides for additional privacy and security requirements that will develop and support electronic health information, facilitate information exchange, and strengthen monetary penalties.
True
Data mining of healthcare information may lead to new human health insights and treatment discoveries.
False
Digitized healthcare information is the leading cause of healthcare information complexity.
Challenges to interoperability
Healthcare variability of services, products, systems, lack of motivation, numerous clinical domains, EHR's formats, protocols for information transmission, integrating new software and hardware, customizing any standards, and high levels of information are
Care quality is intended to be improved by making critical patient information available at the point of care delivery and through the aggregation and mining of data to determine best practices in diagnosis and treatment.
How is care quality intended to improve through the implementation of health information technology?
Centralized model
In this model of health information exchange architecture, data are stored in a shared data repository.
DIRECT exchange
Launched in March 2010 as a part of the Nationwide Health Information Network, the Direct Project was created to specify a simple, secure, scalable, standards-based way for participants to send (push) authenticated, encrypted health information directly to known, trusted recipients over the Internet.
Federated Model
Model of health information exchange where there is not a centralized database of patient information; also known as decentralized model.
Consumer-mediated exchange
Provides patients with access to their health information allowing them to manage their healthcare online in a similar fashion to how they might manage their finances through online banking.
Record locator service (RLS)
Provides the ability to identify where records are located based upon criteria such as a person ID and/or record data type as well as provides functionality for the ongoing maintenance of this location information.
Certified Electronic Health Record Technology (CEHRT)
Standards used to inform technology vendors and providers about the functionality required to receive incentive payments for the implementation of EHR technology in the CMS EHR incentive program.
Consumer mediated exchange
The Blue Button Initiative is an example of what kind of health information exchange model:
Increase the use of health IT
The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 was passed to the address the following.
providing the vision, initiating pilot programs through funding and guidance initiatives, and ensuring that the efforts of public and private stakeholders are coordinated to fulfill the goals of interoperable health information exchange.
The ONC has led the way in implementing interoperable health information exchange by:
Interoperability
The capability of different information systems and software applications to communicate and exchange data. (HIMSS)
Health Information Exchange (HIE)
The exchange of health information electronically between providers and others with the same level of interoperability, such as labs and pharmacies.
communications; patient safety; use of evidence-based medical practice; metrics reporting; and preventative medicine initiatives.
The five categories of value are:
Admit-discharge-transfer (ADT) message
The name given to software systems used in healthcare facilities that register and track patients from admission through discharge including transfers; usually interfaced with other systems used throughout a facility such as an electronic health record or lab information system.
Advisory committee to the US department of Health and Human Services to help the nation transition to electronic health records in support of interoperability standards.
The purpose of the American Health Information Community (AHIC)
The purpose of the NHIN is to provide a nationwide information technology architecture, consisting of rules and standards to use the Internet for exchanging health information in a secure and timely fashion.
The purpose of the NIHN
Health record banking model
This PHR model would allow patients and healthcare providers to share information by making deposits of health information into a bank. The health record bank would have to protect the privacy and security of the health information.
Health information exchange is intended to facilitate access to and retrieval of clinical data to provide safer, timelier, efficient, effective, equitable, patient-centered care.
What are some of the benefits that the health information exchange is expected to deliver to the healthcare industry?
CEHRT standards were implemented to inform technology vendors and providers about the functionality required to receive incentive payments for the implementation of EHR technology in the CMS EHR incentive program.
What are the Certified Electronic Health Record Technology Standards and why are they important?
Meaningful Use was implemented to incentivize the adoption of electronic health records in the healthcare industry.
What is the purpose of the Meaningful Use program?
As the consumer is nudged toward more involvement in their wellness care they will make greater demands for more efficient and better care using all of the technical capabilities that are available.
What role does the consumer have in the future of healthcare delivery?
Centralized
Which model for health information exchange stores patient records in a single database built to allow queries into the system?
Simplify
Which of the following represents an interoperability principle as defined by the ONC?
The ONC published the interoperability roadmap as a high-level guidance document for healthcare industry stakeholders to provide focus, milestones, and expectations for the path toward interoperability within the next 10 years.
Why has the Office of the National Coordinator published the interoperability roadmap? What purpose does it serve for the healthcare industry?
Office of Civil Rights (OCR)
protects fundamental nondiscrimination and health information privacy rights.