Appendix A: Understanding How Providers Exchange Health Information
Although exchange of health information has advanced over the past two decades, with the most significant progress occurring in the past eight years—primarily related to passage of the HITECH Act of 2009 and subsequent increased adoption of EHRs—health care still lags far behind other sectors of the economy in the exchange of information to improve efficiency.54
Historically, providers shared information by facsimile, mail, or phone. New technologies have created a space for greater innovation and coordination within and across health care settings. Starting with secure messaging, increasingly sophisticated technologies have allowed for real-time information sharing across EHR systems. Public and private HIOs have formed in many states and cities to facilitate exchange of information between EHR platforms and across hospital and provider systems. At the same time, standards such as Fast Healthcare Interoperability Resources have enabled new application programming interfaces that have the potential to streamline the flow of information across providers throughout the nation.55 In addition to real-time information flow, EHR and other IT vendors have developed analytical tools to maximize the utility of the data now available, helping providers and health systems track patients at individual and population health levels. Technology advancements also create new opportunities to address important patient privacy issues through data segmentation and consent management tools that can maximize information flow for optimal care while adhering to patients’ privacy preferences.
Electronic exchange of health information can occur in many ways and be led by a variety of entities, including federal, state and local government; private institutions; or a cross-section of such entities. Electronic exchange of health information can be targeted or broad in scope with respect to the amount and kind of information shared and the number of entities participating in exchange. For instance, exchange can occur between a small network of providers, such as a community hospital and ambulatory care clinics; it may be targeted for a specific use case by a large network of providers, such as ADT alerts between hospitals and primary care physicians across a state; or it may involve a central clinical data repository through which all providers in a particular region can access the majority of a patient’s health information.
This section provides an overview of how exchange of health information occurs today and the vehicles and methods for such exchange.