HIE via IHE whitepaper

Note: This is a draft.

Introduction

Purpose

Over the years, organizations of various types in various locations have arisen to facilitate the exchange of health information among disparate clinical information systems. Typically, these health information exchange (HIE) communities develop in metropolitan areas where several healthcare organizations agree to share data among their information systems. Many of these existing communities have recently begun to build upon their exchange capabilities by implementing IHE profiles, notably the IT Infrastructure (ITI) profiles.

Recent increases in federal funding for health information exchange are driving the creation of new HIE communities. For those communities who are starting from a clean slate, we encourage them to explore the capabilities that IHE provides to enable health information exchange. The purpose of this white paper is to describe how HIE communities may be built from the ground up based on IHE profiles.

Overview of HIEs

The HIE concept is not a new one. For many years, there have been ebbs and flows of HIE-like activities across the United States. The nature and scope of these HIE activities vary widly. HIE communities can be characterized by a number of different aspects. First, the geography of the community may vary from one community to another. What often comes to mind when speaking of an HIE community is a regional organization that facilitates information exchange across multiple organization that are relatively close geographically. Major metropolitan areas tend to be the locus of these regional exchanges, but sometimes a regional community may encompass several rural locals. On the opposite extreme of the geographic aspect of HIE communities would be the network of veterans hosptials. The VA (Veterans Administration) hospitals dot the entire map of the US, yet significant efforts have been placed on being able to exchange data among these geographically separated care centers.

A second characteristic by which to categorize HIE communities would be the organizational structure of the community. In some cases, the community consists of a single hospital and several out-patient clinics that have a referral relationship with the hospital. In other cases, a network of competing hospitals, laboratories and private clinics may gather to form an exchange community. Lately, there have been significant initiatives to create state-level exchange communities, which typically take the form of a network of individual HIE communities that already exist in the state.

Finally, a third means by which to describe HIE communities is the scope of the information exchange. Some communities have very limited exchange functionality. For instance, a community may focus entirely on electronic lab result delivery or e-prescribing. Most communities achieve a moderate scope to their exchange activities that might include results delivery, electronic referrals, and perhaps some sharing of encounter-based information (e.g., dictations). More advanced communities leverage their network to include even larger scopes (perhaps including the sharing of patients' consent preferences, exchange of clinical summaries, etc.). No two communities are alike in terms of the set of HIE activities that they facilitate.

Despite all the variance among HIE communities, each have the same ultimate goal: increase the accessibility of patient health information so that clinicians may make more informed decisions about the care that they provide. Likewise, the essense of nearly all of the IHE ITI profiles is to help facilitate the flow of clinical information to the point of care.

Background on IHE

Explain high level IHE concepts such as profiles, actors, transactions, etc. [Chris K] Yes, I think this should include a *brief* overview of IHE (the organization) and the concept of profiling integration (i.e., the technical framework) ....which might include the concept of domains.....with a focus on the Infrastructure Domain profiles

Patient ID management

Explain the importance of managing patient IDs across the community.

PIX

Describe how IDs may be cross-referenced via PIX.

PDQ

Describe how patients may be discovered via demographics queries.

Document sharing

Publish and discover

XDS.b

Describe document sharing via XDS.b.

Also include mention of NAV here.

XCA

Describe cross-community sharing via XCA.

Push to specified recipient

Describe document sharing via XDR and XDM.

Security and privacy

• Explain how profiles like ATNA, XUA and CT help ensure patient privacy via various security measures.
• Explain the concept of HIEs needing to have policies in place that dictate and describe how providers "play" within the HIE.