Guest Column | October 17, 2018

The Future Of HIEs

By Kumar Venkatesiah

The United States government passed the 21st Century Cures Act in December 2016 that paved the way for a more streamlined device and drug approval process. The objective of this act was to bring new treatments to the market faster. While the debate in mainstream media focused on the merits of approving drugs based on weaker evidence and bypassing randomized, controlled trials, there were other provisions in the law that were truly remarkable.

One of the key provisions of the bill concerned the use and regulation of Electronic Health Records (EHR). The government stated that the bill would assist in making EHRs more interoperable and thereby make patient care more seamless.

This brings us to the current state of Health Information Exchanges (HIE) and what their future is going to look like. HIEs were established with a view to make ‘continuity of care’ seamless. HIEs make it possible for institutions to quickly and effectively access clinical details of a patient through a central server. This way, different healthcare centers may be in sync when it comes to helping a patient with their treatment plan.

Another objective of an HIE is to reduce the expenses incurred with traditional data exchange methods. According to a study published by the Sushoo Health Information Exchange, HIEs help a single-clinician practice save as much as $17,160 each year.

Challenges With Interoperability

HIEs provide the platform for healthcare organizations to collaborate with one another on patient EHRs. Traditionally, these organizations worked with health IT vendors like Epic, Cerner or McKesson to manage EHRs. A clinic that wanted access to a patient record would be required to connect to these databases separately to retrieve the relevant records. With an HIE, all these databases are centralized so that one request is sufficient to access and retrieve EHR information from one of these many databases.

There are a couple of challenges with interoperability. The first is with the technology itself. Many healthcare centers today make use of encoders to transcribe the details regarding a patient’s visit to the EHR. Although the use of ICD-10-CM codes have been made mandatory since 2015, there have been a number of instances in recent times where a claim was rejected due to wrong ICD-10 codes. Also, there are concerns that the coding technology is not agile enough to capture all the latest diagnostic tools and processes. This challenge is going to be further tested with the Cures bill that advocates faster deployment of new drugs and treatments.

The second challenge is with respect to logistics of the process. Some experts believe that health centers lose their control over the use-cases of EHR that are specific to their needs. More importantly, they come with high risks since privacy and security controls established by an HIE may not be under a health center’s control. Such centers could thus fall foul of HIPAA guidelines.

Perhaps the biggest obstacle to seamless interoperability is the lack of a global standard. More than a million Americans travel overseas each year for medical treatments, and this number is only expected to grow. Without a global standard in encoding, there is no real way to ensure continuity of care for these patients who get a part of their treatment done overseas. ICD-10-CM, the most recent encoding update took nearly twenty years from conception to implementation. Bringing a new coding system that is universally acceptable remains a pipe dream for now.

Challenges With Seamlessness

An effective outcome of interoperability is to make the process more seamless. But there are challenges to this even outside of interoperational issues. One issue is with the lack of recorded information itself. In a recent hearing on the innovation in healthcare, Aledade Chief Administrative Officer Sean Cavanaugh pointed out that many hospitals regard EHRs as proprietary information and that provides them with a competitive advantage. In essence, they refuse to share details. Consequently, primary care providers (PCPs) often have little to no information regarding a patient’s ADT (Admission, Discharge & Transfer) data. As long as healthcare centers are not mandated to provide share these details, a seamless transfer of EHRs between healthcare providers is unattainable.

The Future Is Integrations

Given these challenges, it may seem like HIEs may fail to live up to their potential. However, there are a few things going for them. The popularity of HIEs today is because of the platform it is built on. Cloud-based access and inexpensive storage solutions have made HIEs grow in popular over the past five years. However, the next phase of growth is expected to come from integrations.

EHRs are already being used in many ways to assess the overall health situation in the country. Clinics across the country use EHRs of patients to predict the spread of an epidemic, as it was in the case of the H1N1 or Ebola. With HIEs, it is possible to integrate patient health records from clinics not just across the state, but also the country or even internationally. This makes it possible for health professionals to detect outbreaks and nip an epidemic in the bud.

While there are challenges with respect to standardization of records, integration is not completely out of question. Most EHRs are today stored on a cloud server. This makes it possible for these databases to be connected through the use of APIs. Application Programming Interfaces (APIs) let one database interact with another with the help of third-party scripts that do not expose the security layer behind each of these databases.

Integration between two HIPAA-compliant systems could thus be easily achieved and this could pave the way for an integrated HIE that goes beyond what is possible today. For instance, new patient records from all across the country could be processed with deep learning and machine learning techniques to detect infections in the bud. Machine learning could also be used on a real-time basis to find patterns in diagnostic procedures that could create AI diagnostic tools. And most importantly, all of this could be achieved without having to wait for a truly interoperable and seamless HIE.

About The Author

Kumar Venkatesiah is an eLearning consultant from India with more than nine years of experience. He works with telemedicine startups to help onboard new clients to the digital platform. You may reach him at