Health information exchange might be a challenge for some providers, but it’s become less of an issue for members of the Northern California HIE Collaborative. Between 2013 and 2015, clinical summary exchange volume increased by 1,349 percent across 11 healthcare organizations that belong to the collaborative.
That’s the finding of a new study published in the Journal of the American Medical Informatics Association, which examined the relationship between electronic exchange of patient health information across organizations and organizational HIE policy decisions. It is the first large-scale empirical study to examine local HIE organizational policy decisions in a diverse group of health systems and to assess their impact on the volume of information exchange, its authors say.
The HIE policies of the 11 health systems helped enable the dramatic increase in the volume of exchange over the two-year period, contends Julia Adler-Milstein, co-author of the article and assistant professor in the School of Information and School of Public Health at the University of Michigan.
“All healthcare organizations wrestle with the same kind of operational decisions around how to implement HIE,” says Adler-Milstein, adding that all 12 members of the Northern California HIE Collaborative have Epic electronic health record systems and its associated HIE platform, called Care Everywhere. She said 11 of the 12 health systems consented to have their data analyzed for the study.
Nine of the 11 organizations’ Epic EHR systems were set up to enable an auto-querying feature, which was associated with a significant increase in the monthly rate of exchange. The JAMIA article notes that Epic employs an “all or nothing” approach in which any organization that participates in its exchange network must wholly agree to rules that define appropriate use of transmitted data as well as other governance issues. That approach eliminates the need for participating organizations to negotiate terms with each organization in the network.
“If an organization has auto-query enabled, there is an attempt to establish a patient link for each visit, and if there is information available, the link is established,” states the JAMIA article. “If an organization does not have auto-query enabled, a user must take the time to seek out information before or during the visit.”
“As soon as an organization turns on auto-query, it means that any patient visit triggers the system to automatically search for any potential relevant information about the patient in any of the other sites,” observes Adler-Milstein. “That was a big driver of the increase in information exchange.”
In addition, seven of the 11 organizations did not require patient consent specifically for HIE, and these organizations experienced a greater increase in volume of exchange over time, compared with organizations that required consent.
“The implications of these decisions ripple through the network. When one organization requires patient consent, that changes the processes that have to go on in all of the other organizations,” contends Adler-Milstein. “The more your organization makes policies that favor the flow of information, the more exchange that’s going to take place.”
However, she and the other co-authors of the JAMIA article acknowledge that one of the limitations of their study is that only health systems using a single vendor-based HIE platform were analyzed. “Our findings may not be generalizable to other approaches to HIE, because Epic’s Care Everywhere is somewhat unique in terms of its approach to technical interoperability and standards governance,” the article noted.
“Still, the reason they have been so successful in building up their HIE network is they have created the capabilities and adopted a take-it-or-leave-it governance approach in which they say, ‘If you want to use Care Everywhere, and you’re an Epic site, you must agree to our terms,’ ” she concludes. “There’s no negotiating over data use agreements, which often trip up and slow down the progress of many multi-stakeholder HIE efforts.”
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