Health information exchange might be an issue for few contributors, but it is become less of an issue for members of the Northern California HIE Collaborative. Between the years of 2013 and 2015, clinical summary exchange volume increased by 1,349% across eleven healthcare agencies that belong to the collaborative.
That is the finding of a new study issued in the Journal of the American Medical Informatics Association, which investigated the relationship between electronic exchange of sufferer health information across agencies and organizational HIE policy decisions. It is the 1st large-scale empirical study to analyze the local HIE organizational policy decisions in a diverse group of health networks and to assess their affect on the volume of information exchange, its authors claim.
The HIE policies of the eleven health systems assisted to enable the dramatic increase in the volume of exchange over the 2-year period, asserts Julia Adler-Milstein, co-author of the article and assistant professor in the School of Information and School of Public Health at the University of Michigan.
“All healthcare agencies wrestle with the similar type of operational decisions around how to execute HIE,” claims Adler-Milstein, adding that all twelve members of the Northern California HIE Collaborative have Epic electronic health record systems and its associated HIE platform, called Care Everywhere. She stated that 11 of the 12 health networks consented to have their data observed for the study.
9 of the 11 agencies’ Epic EHR systems were set up to enable an auto-querying feature, which was associated with an important increase in the monthly amount of exchange. The JAMIA article points out that Epic employs an “all or nothing” access in which any agency that engages in its exchange network must wholly agree to principles that define suitable use of transmitted information as well as other governance problems. That approach eradicates the requirement for participating agencies to discuss terms with each agency in the network.
“If an agency has auto-query enabled, there is an attempt to develop a patient link for each visit, and if there is data available, the link is developed,” claims the JAMIA article. “If an agency doesn’t have auto-query enabled, a user must take the time to seek out data before or during the visit.”
“As soon as an agency turns on auto-query, it means that any sufferer visit triggers the system to automatically search for any potential relevant data about the patient in any of the other sites,” analyzes Adler-Milstein. “That was a big driver of the increase in data exchange.”
Furthermore, seven of the eleven agencies didn’t need patient consent particularly for HIE, and these agencies experienced a greater increase in volume of exchange over time, compared with agencies that needed consent.
“The implications of these decisions ripple through the network. When 1 agency needs patient consent, that changes the procedures that have to go on in all of the other agencies,” contends Adler-Milstein. “The more your agency makes policies that favor the flow of data, the more exchange that is going to take place.”
Although, she and the other co-authors of the JAMIA article appreciate that one of the limitations of their research is that only health systems utilizing a single vendor-based HIE platform were observed. “Our findings may not be generalizable to other approaches to HIE, because Epic’s Care Everywhere is somewhat distinctive in terms of its approach to technical interoperability and standards governance,” the article noted.
“Yet, the reason they have been so victorious in building up their HIE network is they have made the capabilities and adopted a take-it-or-leave-it governance approach in which they say, ‘If you need to use Care Everywhere, and you are an Epic site, you must agree to our terms,’ ” she summarizes. “There is no negotiating over data use agreements, which often trip up and slow down the progress of several multi-stakeholder HIE attempts.”
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