Health Information Exchanges (HIEs) are entities often built on a series of often bilateral legal agreements between different, often proprietary information systems to be able to share certain kinds of data.
Many HIEs were developed for the purpose of aggregating health measures at the community level. Originally conceived in response to the fact that physicians, hospitals, insurers, and other healthcare entities have been reluctant to share data beyond their corporate boundaries, they are typically state or regional entities set up to facilitate health information exchange in a region or market area. Their primary responsibility historically has been to establish “trust relationships” among these entities in order to enable the broadest possible health data exchange. They also facilitate the governance, data-sharing agreements, scope, technology, and financial models needed to support that exchange.
Conceptually, HIEs might be considered the mirror image of the enterprise EHR model. Their purpose is to locate all currently available electronic information on a patient from any source, in that community or region, and present it in an integrated format to any physician who is authorized to view it. Current electronic sources for these data are national and regional laboratories, pharmacies, and clinical claims data. The physician sees, therefore, information from other physicians caring for their patient, records on medications, lab test results, and, as it is made available, copies of hospital discharge summaries and eligibility and claims status.
However, HIEs have been limited by the administrative burdens of obtaining data-sharing agreements at every practice and every hospital or nursing home. They also have been hampered by a lack of financial incentives to develop more coordinated and efficient use of resources (including information resources). In addition, the level of clinical detail in these agreements does not match the richness of information available from a clinical record. Nevertheless, they do provide the treating physician with the information that generally is most important to know about a patient, which can make a very big difference in patient outcomes.