“Our vision is better health enabled by data.” Those words are front-and-center on HealthIT.gov, the official website of the Office of the National Coordinator for Health Information Technology (ONC). In fact, in its “Playbook” for Health Information Exchange (HIE), the ONC explains, “Facilitating electronic exchange of this health information is critical to easing burden by ensuring that clinicians have the best information possible when making decisions about patient care.”  So what is it, why should care and how does automated prior authorization support it?

What is HIE? 

HIE, or Health Information Exchange, refers to sharing of electronic health information in real time, including: 

• Patient health records
• Medical test results
• Other health-related data

The ONC has defined three types of HIE. 

Directed exchange 

This refers to sharing patient information, easily and securely, directly between healthcare professionals. This allows a physician, for example, to make referrals that include all relevant patient medical history or order laboratory tests with other providers in a patient’s care continuum, improving care coordination. Directed exchange is also the method used to send immunization data to public health organizations and to report quality measures to The Centers for Medicare & Medicaid Services (CMS). 

Query-based exchange

This type of exchange enables providers to search and discover clinical information on a patient. Take an emergency room visit. When a patient enters the ER, an HIE removes the guesswork. ER physicians can run a search on the HIE and pull up relevant information about the patient, including prescribed medications, pre-existing conditions and more. This helps the treating physician initiate a more focused treatment plan.

Consumer-mediated exchange 

This refers to patient access to health information. It allows patients to be more involved in their own care, including choosing which providers can access their data and tracking their own health through test results over time. 

What Benefits Does HIE Offer?

An EHR Intelligence article notes, “Health information exchanges (HIEs) are well-situated to help healthcare organizations achieve the triple aim of value-based care—improving population health management strategies, providing better care for individuals, and reducing healthcare costs.” In fact, the triple aim has morphed into a quadruple aim—adding improved clinical experiences. And there’s talk of establishing a quintuple aim to address health equity. HIE promises to help with both. 

Here’s a breakdown of the advantages of smooth, secure HIE. 

• Improved care coordination among healthcare providers.
• Enhanced patient safety by reducing medical errors caused by missing information, such as medication allergies.
• Increased efficiency by eliminating faxes and phone calls in favor of exchanging data. seamlessly between systems. (Something prior authorization software does.) 
• Lower costs by reducing duplicate tests or procedures and improving treatment plan decisions for better health outcomes over time.

In fact a study of HIEs found proof that they contribute to lower healthcare costs for at least 68% of respondents. The study’s lead investigator, Nir Menachemi, a professor in the Indiana University Richard M. Fairbanks School of Public Health, explains, “Up until this point, the promise of health information exchanges to improve care and reduce costs has been theoretical. We now have reasonably strong evidence that there are benefits to using health information exchanges.”

What are the Barriers to Efficient HIE?

Of course, HIE doesn’t happen without some challenges. (And you’re probably quite familiar with some of them.) 

The lack of interoperability between different systems can make it difficult to share health information between healthcare providers, organizations, and systems. The 21st Century Cures Act has tackled some of the barriers caused by info blocking, but progress on other aspects of interoperability sometimes feels excruciatingly slow. 

• The lack of consistency and standardization presents problems, making it hard to exchange data because of mis-matched fields when importing data.
• The expense of implementing and maintaining the technical infrastructure can escalate quickly. But you can’t take shortcuts when it comes to enabling data exchange while protecting data privacy and security.
• The regulatory landscape creates a compliance challenge. With federal and state laws in play, it can be a complex undertaking to participate in HIE networks. 

Plus, let’s face it. Change is hard. Some healthcare providers encounter resistance to changing workflows or adopting new technologies needed for participation in HIE networks.

What Best Practices Support HIE?

1. Establish clear policies and procedures for HIE that address data privacy and security, patient consent, data standards, and other critical issues. These policies should be regularly reviewed and updated to reflect changes in laws, regulations, and technology.
2. Adopt standardized data formats and protocols for the exchange of health information to ensure interoperability between different EHR systems and healthcare providers.
3. Engage patients in the HIE process by providing clear and concise information about the benefits and risks of HIE, obtaining informed consent, and providing patients with the ability to control access to their health information.
4. Provide healthcare providers with training and support. This includes training on data privacy and security, data standards, and best practices for using HIE to improve patient care.
5. Regularly evaluate the effectiveness of HIE networks and systems to identify areas for improvement. This includes monitoring the quality and completeness of health information, identifying gaps in data sharing, and addressing issues related to data privacy and security.

What Role do FHIR APIs Play in HIE?

Fast Healthcare Interoperability Resources (FHIR) APIs play an increasingly important role in Health Information Exchange (HIE). FHIR APIs provide a standardized method for accessing and exchanging patient health information between different entities, enabling efficient and secure HIE. In fact, Myndshft uses FHIR APIs to support seamless communication and data exchange between providers and payers to deliver automated, end-to-end prior authorization. 

To learn more about Myndshft prior authorization software or arrange a personalized demo, contact us.