The practice of emergency medicine/concepts
Health Information Exchange in Emergency Medicine

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Emergency physicians often must make critical, time-sensitive decisions with a paucity of information with the realization that additional unavailable health information may exist. Health information exchange enables clinician access to patient health information from multiple sources across the spectrum of care. This can provide a more complete longitudinal record, which more accurately reflects the way most patients obtain care: across multiple providers and provider organizations. This information article explores various aspects of health information exchange that are relevant to emergency medicine and offers guidance to emergency physicians and to organized medicine for the use and promotion of this emerging technology. This article makes 5 primary emergency medicine–focused recommendations, as well as 7 additional secondary generalized recommendations, to health information exchanges, policymakers, and professional groups, which are crafted to facilitate health information exchange's purpose and demonstrate its value.

Section snippets

Foreword

In October 2013, the American College of Emergency Physicians (ACEP) Council adopted Resolution 29(13): Support of Health Information Exchanges:

  • Resolved: that ACEP investigate and support health information exchanges

  • Resolved: that ACEP work with appropriate stakeholders to promote the development, implementation, and use of a national health information exchange

  • Resolved: that ACEP develop an information article exploring a national health information exchange

A workgroup was created to

Definitions

The Department of Health and Human Services current definition states that “Health Information Exchange is the electronic movement of health-related information among organizations according to nationally recognized standards. The goal of health information exchange is to facilitate access to and retrieval of clinical data to provide safer, timelier, efficient, effective, equitable, patient-centered care.”3

The terms regional health information organization and health information exchange are

Background and History

Health information exchange has been a key goal of health care since the advent of the modern computer. Limited, closed exchange networks, primarily for research purposes, emerged in the late 1980s. But it was the propagation of the Internet in the early 1990s that enabled technology to extend exchange beyond institutional walls.

The 1990s saw the emergence of community health management information systems funded by grants from the Hartford Foundation to 7 states and cities to implement large

Patient Crossover

Patients often move among providers and hospitals, with significant patient crossover rates in emergency medicine. One study showed that 25% of patients with more than 1 ED visit during a 1-year study period used more than 1 hospital, and those visits composed 19% of all ED visits.11 A similar, more recent study showed that 40% of patients with ED visits during a 3-year study period had data at multiple institutions.12 Another study of all visit types found that 41% of patients had visits at

Health Information Exchange Marketplace

The current health information exchange market can be divided into 2 distinct sectors, each with its own unique needs and requirements:

  • 1.

    Public health information exchanges, often funded by federal, state, and local governments, typically provide health information exchange services across a geographic region or state. Many have struggled to define a sustainable business model and wean themselves from diminishing grant-based start-up funds. This has created a “churn and burn” phenomenon among

Different Types of Health Information Exchange

According to the Office of the National Coordinator for Health Information Technology, currently there are 3 key forms of health information exchange.45 Although query-based exchange is the form that is most often used in emergency medicine and is the primary focus of this article, a brief review of each follows:

  • 1.

    Query-based exchange is used by providers to search for and discover clinical data sources from outside the treating provider’s practice environment for a particular patient. This type

Architectural Overview

Health information exchanges generally fall into one of 3 basic architectures: The centralized model uses a monolithic database that includes data from all stakeholder organizations. The federated model allows each stakeholder organization to maintain either physical or virtual “edge” servers, allowing them to maintain stewardship over the data they contribute. With a federated architecture, each edge server contains a common data structure, and the network of edge servers functions as a

Technical Overview

The elements described below are integral parts of most health information exchange implementations:

Competitive Concerns

Although ownership of health data is often debated,53 many provider organizations consider their stewardship and control of the patient data they generate to be a business asset and may be reluctant to share data with competitors. Provider organizations may be concerned that if data flow freely, patients may have less reason to remain loyal, or that data might be used by competitors to create a strategic market advantage. It has been historically difficult to promote health information exchange

Recommendations

Significant changes in practice and public policies are necessary to support a system of effective national health information exchange that can rapidly and efficiently yield useful health information to clinicians, especially in the emergency care setting. These changes should include support for emergency clinician access to all relevant patient information, in properly summarized understandable form to provide safe, efficient, and effective emergency care. Below we list 5 primary

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  • Cited by (0)

    Supervising editor: Robert L. Wears, MD, PhD

    Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist and provided the following details: Until May 2012, Dr. Taylor was employed by a software company that sells a health information exchange solution. Dr. Panik was an unpaid consultant to one health information exchange and has been both a paid and unpaid consultant to another one.

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