Vehicles for Exchange of Health Information
EHRsExchange of health information across EHRs can occur within a health system or network of providers, such as an ACO, that have affiliated providers who operate different EHR systems as well as between unaffiliated providers. This type of exchange requires interfaces and transport services to facilitate sharing between unique systems. Information exchange across EHR systems may be simpler to employ if providers are using the same EHR vendor or similar technologies.
This road map does not delve into the many characteristics that define a well-organized EHR that is able to effectively exchange data; however it is important for state leaders to recognize the enormous variability in the manner in which providers are capturing, sending, receiving, and using data. Many clinical data systems have significant limitations that restrict the utility of data for the purposes of patient care. The National Committee for Quality Assurance (NCQA) provides an illustrative example of a framework for clinical data systems, which includes the ability to: capture patient care in a structured, electronic format; be maintained over time; include some or all key clinical data relevant to care; facilitate bidirectional, automated sharing of information; and be accessible by the health care team at the point of care. For additional information on NCQA’s framework, please visit: http://www.ncqa.org/hedis-quality-measurement/ecds.
Facilitating EntitiesExchange of health information can occur through a facilitating entity that manages the transport of information and, in some cases, stores information across multiple providers. Facilitating entities can offer a range of services and accompanying infrastructure to support exchange.56
Because there are no uniform national standards for exchange of health information across EHR platforms and health systems, facilitating entities such as HIOs may be perceived as the most obvious solution to accomodate information exchange between providers.57 An HIO can help individual providers or hospital systems avoid establishing unique connections to all other providers with whom they might want to exchange information, but if and when uniform standards are agreed upon, direct provider-to-provider information sharing may become easier and more commonplace.