Guest Column | April 13, 2010

Guest Column: Not All Health Information Exchange Is Created Equal

By John W. Loonsk, MD FACMI, Chief Medical Officer, CGI Federal

There was an effort a little while back to define health IT terms. In that process, a bit of work went into defining "Health Information Exchange" (HIE) as an "act" or "verb" and "Health Information Organizations" as entities dedicated to the exchange of health information. Common usage now seems complicated by the use of three terms; Health Information Exchange, Regional Health Information Organization (RHIO) and Health Information Organization (HIO), but perhaps the bigger challenge is the even greater variation in the details of what any of these terms practically means. The numerous "HIE enabled" products at HIMSS 2010 and the concerns over the recent "NHIN Direct" announcements from ONC suggest needs to better discuss attributes of different HIE approaches and their relationships to the health outcomes that are sought. All of this comes at a time when States need to thoughtfully consider how to advance their HIE responsibilities in the HITECH funding and participate in the developing health IT infrastructure.

Functionally HIE today far from being a consistent organizational description or a uniform shrink-wrapped product, is more like a grab bag of disparate things. "HIE" is used to describe: hospitals sharing lab reports and discharge summaries with affiliated providers; multi-stakeholder Regional or State Health Information Organizations (RHIOs, HIEs, HIOs); the exchange of information among the products of a single EMR vendor; the secure emailing of documents; and, perhaps most simply and broadly, the ability of any piece of software to exchange information. HIE can include information being browsed, "pulled" and/or "pushed," and information that is fully coded with nationally recognized vocabularies or information that is in barely processable document formats.

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