Health information exchange : navigating and managing a network of health information systems

__Health Information Exchange (HIE): Navigating and Managing a Network of Health Information Systems__ allows health professionals to appropriately access, and securely share, patients’ vital medical information electronically, thus improving the speed, quality, safety, and cost of patient care. The book presents foundational knowledge on HIE, covering the broad areas of technology, governance, and policy, providing a concise, yet in-depth, look at HIE that can be used as a teaching tool for universities, healthcare organizations with a training component, certification institutions, and as a tool for self-study for independent learners who want to know more about HIE when studying for certification exams. In addition, it not only provides coverage of the technical, policy, and organizational aspects of HIE, but also touches on HIE as a growing profession. In Part One, the book defines HIE, describing it as an emerging profession within HIT/Informatics. In Part Two, the book provides key information on the policy and governance of HIE, including stakeholder engagement, strategic planning, sustainability, etc. Part Three focuses on the technology behind HIE, defining and describing master person indexes, information infrastructure, interfacing, and messaging, etc. In Part Four, the authors discuss the value of HIE, and how to create and measure it. Finally, in Part Five, the book provides perspectives on the future of HIE, including emerging trends, unresolved challenges, etc. * Offers foundational knowledge on Health Information Exchange (HIE), covering the broad areas of technology, governance, and policy * Focuses on explaining HIE and its complexities in the context of U.S. health reform, as well as emerging health IT activities in foreign nations * Provides a number of in-depth case studies to connect learners to real-world application of the content and lessons from the field * Offers didactic content organization and an increasing complexity through five parts Cover Health Information Exchange Copyright List of contributors Foreword* References Contents Preface Acknowledgments 1 Introduction to health information exchange 1.1 Introduction 1.2 Health information exchange 1.2.1 HIE as a verb 1.2.2 HIE as a noun 1.2.2.1 How HIE is used in this book 1.2.3 Typology of Health Information Organizations 1.2.3.1 Enterprise HIE 1.2.3.2 Community-based HIE 1.2.3.3 Government-facilitated HIE 1.2.3.4 Vendor-facilitated HIE 1.2.3.5 Health record banking 1.2.4 Fundamental components of HIE 1.2.4.1 Health system actors and relationships 1.2.4.2 ICT Systems 1.2.4.3 Transactions or messages 1.2.4.4 Content or payload 1.3 Evolution of health information exchange in the United States 1.4 HIE outside the United States 1.5 Purpose and structure of this book 1.6 Summary Questions for discussion References 2 Health information exchange as a profession 2.1 Introduction 2.1.1 Implementation and adoption of electronic health records and health information exchange 2.1.2 Incentives promoting use of electronic health records and increasing the health information technology workforce 2.1.3 Promoting use of electronic health records and health information exchange globally 2.2 Human resource needs—digital health information professionals 2.2.1 The nature of eHealth/digital health information professionals: their competencies, roles, and work 2.2.2 Who are the eHealth/digital health information professionals? 2.2.2.1 Health informaticians (HI professionals) 2.2.2.2 Residency and fellowship training—clinical informatics subspecialty 2.2.2.3 Health informatics for nonclinicians 2.2.2.4 Health information management professionals 2.2.2.5 Health information technologists or health information and communications technologists 2.2.2.6 Health information security specialists 2.2.2.7 Health data analysts 2.2.2.8 Health information exchange professionals 2.2.3 Other key personnel—clinical healthcare professionals 2.2.3.1 Medical and clinical trainees 2.3 Digital health information professionals—supply and demand 2.4 Skills and training of digital health professionals 2.4.1 Current credentials offered 2.5 Defining and executing a future strategy for health informaticians and health information exchange professionals 2.5.1 Health information workforce development 2.6 Emerging trends 2.6.1 Education 2.6.2 Continued ONC-HIT Workforce Development—public health informatics 2.7 Summary Questions for discussion References 3 Policies and incentives for adoption: toward broader use 3.1 Introduction 3.2 Landscape of the health information exchange marketplace 3.2.1 Adoption of health information exchange functionalities 3.2.2 Evolution of health information exchange organizations 3.2.3 International growth in the adoption of health information exchange 3.2.4 Health information exchange usage by providers 3.2.5 Barriers to adoption 3.2.6 Drivers of adoption 3.2.7 Health information exchange policy at the state and national level 3.3 Emerging trends 3.3.1 New policies to advance health information exchange adoption and use 3.3.2 Blockchain may advance security of health information exchange 3.3.3 Driving health information exchange adoption through Big Data initiatives 3.3.4 Impact of General Data Protection Regulation on health information exchange adoption 3.3.5 Information blocking policies 3.4 Summary Questions for discussion References 4 Engaging and sustaining stakeholders: toward governance 4.1 Introduction 4.2 Governing bodies 4.2.1 Governing body types 4.2.1.1 Board of directors 4.2.1.2 Network governing committee 4.2.1.3 Data governance committees 4.2.2 Participants 4.2.3 Representativeness 4.3 Policies and procedures 4.4 Data sharing “Trust” agreements 4.5 Governance key success factors 4.5.1 Trust 4.5.2 Scale 4.5.3 Flexibility 4.6 Governance challenges 4.7 Enterprise exchange challenges 4.8 Regional exchange challenges 4.9 State health information organization challenges 4.10 Nationwide exchange challenges 4.11 Community-based health information exchange network governance example: Indiana Network for Patient Care 4.12 Government-facilitated health information exchange network example: Virginia Health Information 4.13 National health information exchange network governance example: eHealth Exchange 4.14 Emerging trends 4.15 Summary Questions for discussion References 5 Managing the business of health information exchange: moving towards sustainability 5.1 Introduction 5.2 Sustainability for the various forms of health information exchange is different 5.2.1 Sustaining enterprise health information exchange networks 5.2.2 Sustaining government-facilitated health information exchange networks 5.2.3 Sustaining vendor-facilitated health information exchange networks 5.2.4 Sustaining Health Record Banks 5.2.5 Sustaining community-based health information exchange networks 5.3 Business 101 for Health Information Organizations 5.3.1 Key business definitions 5.4 Hypothetical case study to illustrate sustainability 5.5 Increasing health information exchange revenue 5.5.1 Increasing revenue by adding customers 5.5.2 Increasing revenue by adding services 5.6 Increasing the gross margin per service 5.6.1 Setting prices 5.6.2 Reducing the cost of service delivery 5.7 Reducing overhead costs of an health information exchange business 5.8 Planning for sustainability 5.8.1 Start with sustainability in mind 5.8.2 Mission 5.8.3 Organizational structure 5.8.4 Business model 5.8.5 Dissemination of the value of the health information exchange network 5.9 Challenges to sustainability 5.10 Health data utilities, an emerging model for health information exchange networks 5.11 Summary Questions for discussion References 6 Managing privacy, confidentiality, and risk: towards trust 6.1 Introduction 6.1.1 Privacy 6.1.2 Confidentiality 6.1.3 Security 6.1.4 Accountability 6.1.5 Privacy risk 6.2 Federal and state laws pertaining to health information exchange 6.2.1 Sensitive data 6.2.2 HIPAA and the HITECH Act 6.2.3 What is regulated? 6.2.4 The Privacy Rule and the Security Rule 6.2.5 The Privacy Rule 6.2.6 The Security Rule 6.2.7 Managing privacy risks 6.2.8 Breach notification rule 6.2.9 HIPAA enforcement 6.3 Information blocking regulations 6.4 Contracts 6.4.1 Point-to-point agreements 6.4.2 Two-party agreements 6.4.3 Multiparty agreements 6.5 Summary Questions for discussion References 7 Managing threats to health data and information: toward security 7.1 Introduction 7.1.1 Healthcare information security regulations 7.1.1.1 HIPAA Security Rule 7.2 Health Information Technology for Economic and Clinical Health Act 7.3 Breach Notification Rule 7.3.1 What’s really considered Unsecured Protected Health Information 7.3.2 Ransomware, HIPAA, and HITECH Act Breach Notification Rule implications 7.3.3 Vulnerabilities and breaches 7.4 21st Century Cures Act Final Rule 7.5 NIST Cybersecurity Framework 1.1 7.5.1 Global regulations and frameworks 7.5.2 ISO/IEC 27001 7.5.3 European Union General Data Protection Regulation 7.5.4 Operationally Critical Threat, Asset, and Vulnerability Evaluation (OCTAVE) 7.5.5 OCTAVE Allegro 7.6 Technical risk management analysis methods 7.6.1 Vulnerability Scanning 7.6.2 CIS Critical Security Controls 7.6.3 HITRUST Common Security Framework (CSF) 7.6.4 MITRE ATT&CK 7.6.5 Mitre D3FEND 7.6.6 Penetration Testing, Red Teams, Blue Teams, and Purple Teams 7.7 Risk assessments, risk management plans, and risk registers in the healthcare management process for Health Information... 7.7.1 OCTAVE FORTE for Health Information Exchange networks and modern needs 7.7.1.1 Step 1—Establish risk governance and appetite 7.7.1.2 Step 2—Scope critical services and assets 7.7.1.3 Step 3—Identify resilience requirements of assets 7.7.1.4 Step 4—Measure current capabilities and Step 5—Identify risks, threats, and vulnerabilities to assets 7.7.1.5 Step 6—Analyze risks against capabilities 7.7.1.6 Step 7—Plan for response 7.7.1.7 Step 8—Implement the response plans 7.7.1.8 Step 9—Define metrics 7.7.1.9 Step 10—Review, update, and repeat 7.8 Emerging trends 7.8.1 Trusted Exchange Framework and Security 7.8.2 Blockchain/Distributed Ledger Technologies 7.8.3 Decentralized Identifiers 7.9 Summary Questions for discussion References 8 Architectures and approaches to manage the evolving health information infrastructure 8.1 Introduction 8.2 The health information infrastructure 8.2.1 The health information infrastructure is an Ultra Large-Scale system 8.3 Supporting the health information infrastructure 8.3.1 Architecture 8.3.2 Transactions 8.3.3 Interoperability 8.3.3.1 Foundational interoperability 8.3.3.2 Syntactic interoperability 8.3.3.3 Semantic interoperability 8.4 Open HIE—a model health information infrastructure 8.4.1 Business domain services 8.4.2 Registry services 8.4.3 Interoperability layer 8.4.4 Structure of the interoperability layer 8.4.5 Core component 8.4.5.1 Security 8.4.5.2 Monitoring/logging 8.4.6 Mediation component 8.4.6.1 Adapters 8.4.6.2 Orchestrators 8.5 Benefits of the OpenHIE interoperability layer 8.6 Emerging trends 8.7 Summary Questions for discussion References 9 Syntactic interoperability and the role of syntactic standards in health information exchange 9.1 Introduction 9.2 Defining syntactic interoperability: definition and need 9.3 Common syntactic standards relevant for health information exchange 9.3.1 Health Level Seven International standards 9.3.1.1 HL7 v2 messaging standard 9.3.1.2 HL7 CDA document standard 9.3.1.3 Fast Healthcare Interoperability Resources 9.3.2 Digital Imaging and Communications in Medicine 9.3.3 National Council for Prescription Drug Programs 9.3.4 X12 standards in health care 9.4 How standards are developed for health care 9.5 How syntactic standards are used and supported in the real world 9.5.1 Implementation guides 9.5.2 Interface engines 9.5.3 Health information exchange services 9.5.3.1 Integrating the Healthcare Enterprise 9.5.3.2 eHealth Exchange 9.6 Emerging trends 9.6.1 Transferring bulk data: Flat FHIR 9.6.2 Clinical decision support and quality measurement: Clinical Quality Language 9.6.3 Research: OMOP Common Data Model 9.6.4 Clinical information models: the Gender Harmony Project 9.6.5 Trusted Exchange Framework and Common Agreement 9.7 Summary Questions for discussion References 10 Standardizing health care data across an enterprise 10.1 Introduction 10.2 Role of terminologies in health care 10.3 Standard terminologies in health care 10.4 Selection of standard terminologies for health information exchange 10.5 Current use of standard terminologies 10.6 Mapping 10.6.1 Equivalence 10.6.2 Mapping process 10.6.3 Fitness for purpose 10.7 Terminology Services 10.7.1 Implementation of Terminology Services 10.7.2 Terminology Service support 10.7.3 Evaluation of Terminology Services 10.8 Emerging trends 10.9 Summary Questions for discussion References 11 Shared longitudinal health records for clinical and population health 11.1 Introduction 11.2 Shared longitudinal records for clinical health 11.3 Shared longitudinal records for population health 11.3.1 Population health dashboards and indicators 11.3.2 Disease surveillance 11.3.3 Medical research 11.4 Implementation 11.4.1 SHR implemented as an EHR 11.4.2 SHR implemented as a database 11.4.2.1 Relational database management system 11.4.2.2 Not only SQL DBMS 11.4.3 HMIS implemented as data analysis platform 11.4.4 Data quality challenges to implementation 11.5 Emerging trends 11.5.1 Postpandemic infrastructure redesign 11.5.2 Learning health systems 11.5.3 Social determinants of health 11.6 Summary Questions for discussion References 12 Client registries: identifying and linking patients 12.1 Introduction 12.2 Patient identifiers 12.3 Unique patient identifiers 12.3.1 Attributes of ideal identifiers 12.3.2 Social security number 12.3.2.1 Biometric identifiers 12.3.3 International unique patient identifiers 12.4 Client registries 12.5 The Enterprise Master Patient Index 12.6 Data quality 12.7 Metadata and standards 12.8 Algorithmic matching 12.8.1 Basic concepts of matching 12.8.2 Field comparison methods 12.8.3 Blocking 12.8.4 Decision models 12.8.4.1 Deterministic matching 12.8.4.2 Probabilistic matching 12.8.4.3 Machine learning–based linkage methods 12.8.4.4 Statistical matching 12.8.4.5 Hybrid methods of record linkage 12.8.4.6 Privacy preserving record linkage 12.8.5 Linkage quality metrics 12.8.6 Biases in record linkage 12.8.7 User interface 12.9 Emerging trends 12.9.1 Data quality 12.9.2 Biometrics 12.9.3 Hybrid matching algorithms 12.9.4 Location intelligence 12.9.5 Patient engagement 12.9.6 National strategic framework for identity matching 12.10 Summary Questions for discussion References 13 Facility registries: metadata for where care is delivered 13.1 Introduction 13.2 Facility registry background 13.3 Implementation of a health facility registry 13.4 The value of facility registries 13.4.1 Care coordination 13.4.2 Quality improvement 13.4.3 Public health 13.5 Components of a facility registry 13.6 Facility registry functionality 13.7 Data specification 13.7.1 Signature domain 13.7.2 Service domain 13.8 Creating unique identifiers 13.8.1 World Health Organization candidate identifiers 13.8.1.1 Integer codes 13.8.1.2 Facility codes 13.8.1.3 Universally unique identifiers 13.8.1.4 The Tanzanian facility identifier number 13.8.2 Other candidates for creating unique identifiers 13.8.2.1 Object identifiers 13.8.2.2 National provider identifiers 13.8.2.3 Health industry numbers 13.9 Data sources for constructing the master facility list 13.10 An example from the US social security administration 13.11 Mapping disparate facility data 13.12 Emerging trends 13.13 Summary Questions for discussion References 14 Health worker registries: managing the health care workforce 14.1 Introduction 14.2 Need for coordinated health care worker data 14.3 Health worker registries 14.4 Health worker registries within a health information exchange 14.5 Existing minimum data sets 14.6 Creation of minimum data sets 14.7 Standards to support the minimum data set 14.8 Emerging trends 14.8.1 A health care provider directory for the United States 14.8.2 Health worker registries support operational health system needs 14.8.3 Registries for community health workers 14.9 Summary Questions for discussion References 15 Healthcare finance data exchange: toward universal health coverage 15.1 Introduction 15.2 Role of claims in health information exchange to achieve universal health coverage 15.2.1 What is claims processing? 15.3 Claims processing in the United States and Europe 15.3.1 United States 15.3.2 Europe 15.3.2.1 Claims processing in the Netherlands 15.4 Claims processing systems in Low-and-Middle Income Countries 15.4.1 Open-source Insurance Management Information System 15.4.2 Implementation of openIMIS 15.4.2.1 Nepal 15.4.2.2 Tanzania 15.4.2.3 Chad 15.4.2.4 Cameroon 15.4.2.5 Democratic Republic of Congo 15.5 OpenHIE and claims processing 15.5.1 Proposed function of health financing in OpenHIE Architecture 15.5.2 Interoperability use cases 15.6 Summary Questions for discussion References 16 Evidence base for health information exchange 16.1 Introduction 16.2 Methods 16.3 Evidence base for the effect of Health Information Exchange on health outcomes 16.3.1 Period 1 (January 1980–May 2014) overview 16.3.2 Period 2 (June 2014–June 2017) overview 16.3.3 Period 3 (July 2017–December 2021) overview 16.3.4 Descriptive characteristics from contemporary literature 16.3.5 Evolution of evidence of the effects of Health Information Exchange over time 16.3.6 Gaps in the current evidence 16.4 Conclusion Questions for discussion References 17 Measuring the value of health information exchange 17.1 Introduction 17.2 The spectrum of evaluation 17.2.1 Evaluation categories 17.2.1.1 Formative evaluation 17.2.1.2 Summative evaluation 17.2.1.3 Scientific research 17.2.2 Domains of evaluation 17.3 Developing an evaluation plan 17.3.1 The evaluation team 17.3.1.1 Evaluation methodology 17.3.1.2 Health care operations 17.3.1.3 Technical implementation 17.3.1.4 Clinical care 17.3.1.5 Project management 17.3.1.6 Patient (consumer) representation 17.3.2 Defining goals, objectives, and stakeholders 17.3.3 Identifying potential measures 17.3.4 Designing the evaluation 17.3.5 Data sources 17.3.6 Assessing feasibility of evaluation measures 17.3.7 Finalizing the plan 17.4 Dissemination of findings 17.4.1 Strategies for success 17.5 Emerging trends 17.5.1 A growing evidence base 17.5.2 Return on investment 17.6 Summary Questions for discussion References 18 Leveraging HIE to facilitate large-scale data analytics 18.1 Introduction 18.2 Foundations for analytics 18.3 Analytical maturity 18.4 Analytical approaches 18.4.1 Descriptive analytics 18.4.2 Predictive analytics 18.4.3 Prescriptive analytics 18.5 Drivers of analytics in health systems 18.6 How does analytics support promoting interoperability and reporting goals? 18.7 How can HIOs provide real-time analytics to meet population health goals? 18.7.1 HIOs as enablers of analytics 18.7.2 HIOs as a provider of analytics-as-a-service 18.7.3 HIO use of a vendor-supplied analytics platform 18.7.4 Conveying value 18.8 Barriers to analytics 18.8.1 Low-to-middle-income countries 18.8.2 Barriers to HIE analytics 18.8.2.1 Financial 18.8.2.2 Data collection 18.8.2.3 Methodology selection 18.8.2.4 Organizational 18.9 Impact of HIE architecture models on analytics 18.10 Emerging trends 18.11 Summary Questions for discussion References 19 Health information exchange: incorporating social and environmental determinants of health into health information exchange 19.1 Introduction 19.2 Section 1. Defining social determinants of health 19.2.1 Economic stability 19.2.2 Education access and quality 19.2.3 Healthcare access and quality 19.2.4 Neighborhood and built environment 19.2.5 Social and community context 19.3 Section 2. The role of health information exchange in social determinants of health 19.4 Section 3. Incorporation of social determinants of health into health information exchange 19.4.1 Data collection and storage 19.4.1.1 Data management 19.4.2 Aggregate/population data 19.4.3 Person-level data 19.4.4 Metadata/hierarchies 19.5 Emerging trends 19.6 Summary Questions for discussion References 20 Cross-border Health Information Exchange to Achieve World Health Outcomes 20.1 Introduction 20.2 Cross-border Health Information Exchange 20.2.1 United States 20.2.1.1 Patient-Centered Data Home 20.2.2 Africa 20.2.3 Europe 20.2.3.1 Legal and financial aspects 20.2.3.2 Towards the European Health Data Space (TEHDAS) 20.2.4 Latin America 20.2.4.1 Brazil & French Guiana 20.2.4.1.1 Study area 20.2.4.1.2 Data sources & Definition of Cross-Border Malaria Cases 20.2.4.1.3 Data Harmonization System 20.3 Summary Questions for Discussion References 21 Future directions for health information exchange 21.1 Introduction 21.2 A unified approach to nationwide exchange 21.2.1 Federal support for health information exchange 21.2.2 The health information exchange landscape 21.2.3 Nationwide exchange 21.2.4 Trusted Exchange Framework and Common Agreement basics 21.2.5 Trusted Exchange Framework and Common Agreement launch 21.2.6 Considerations for the future 21.3 An emerging challenge: usability of interoperability 21.3.1 The emerging challenge of interoperability usability 21.3.2 Potential solutions 21.3.3 Key challenges to data integration 21.3.4 Considerations for the future 21.4 International policies impacting health information exchange 21.4.1 Joint Action Towards the European Health Data Space 21.4.2 African Union health information exchange efforts in support of public health 21.4.2.1 A framework for health information exchange in Africa 21.5 Models of health information exchange postpandemic 21.5.1 Why evolve health information exchange into a public utility? 21.5.2 What is a public health data utility? 21.5.3 A disruptive model for health information exchange 21.5.4 Advantages for public health data utilities 21.5.5 Challenges to public health data utilities and the future 21.6 Conclusion Questions for discussion References 22 The Indiana Health Information Exchange Major themes 22.1 Introduction 22.2 Context 22.3 The Indiana Health Information Exchange 22.3.1 Organization 22.3.2 Community engagement 22.3.3 Use 22.3.4 Financial model 22.3.5 Technical approach 22.3.6 Privacy and confidentiality 22.3.7 Services 22.3.7.1 OneCare 22.3.7.2 PopCare 22.3.7.3 GovCare 22.3.7.4 Other services 22.3.8 Lessons learned 22.4 Summary Questions for discussion References 23 Using health information exchange to support public health activities in Western New York: a case study 23.1 Introduction 23.2 Background and context 23.3 Health information exchange and public health 23.3.1 Uses of health information exchange in public health 23.3.2 Public health emergencies 23.3.3 Reporting to public health agencies 23.3.4 Public health alerting 23.3.5 Clinical care 23.3.6 Public health services 23.4 Intervention, planning, and assessment 23.4.1 Uses of HEALTHeLINK to provide public health services 23.4.1.1 COVID-19 23.4.1.2 Chlamydia 23.4.1.3 Gonorrhea 23.4.1.4 Syphilis 23.4.1.5 Hepatitis surveillance 23.4.1.6 Rabies investigations 23.4.1.7 Foodborne illness outbreaks 23.4.1.8 Tuberculosis 23.4.1.9 Quality audits to track infection control in hospitals 23.4.1.10 Tracking nursing home and long-term care infections 23.4.1.11 HIV investigation and contact tracing 23.4.2 Challenges 23.4.3 Contributors to success 23.5 Summary Lessons learned Questions for discussion References 24 Creating a 21st century health information technology infrastructure: New York’s Health Care Efficiency and Affordabilit... Major themes 24.1 Introduction 24.2 Background: the Health Care Efficiency and Affordability Law for New Yorkers Capital Grant Program 24.3 Case study: the evolution of health information exchange organizations in New York State 24.4 HEAL NY Phase 1 (2005–08) 24.5 HEAL NY Phase 5 (2007–10) 24.6 HEAL NY Phases 10, 17, and 22 (2009–14) 24.7 New York State’s evolution during the period of federal action: HITECH Act and Meaningful Use Stages 1 & 2 (2008–14) 24.8 The current state of health information exchange in New York State 24.9 Summary Questions for discussion References 25 Use of Health Information Exchanges for value-based care delivery and population health management: a case study of Mary... 25.1 Introduction 25.2 Value-based care and Accountable Care Organizations 25.2.1 Background 25.2.2 Accountable Care Organization concept 25.2.3 Value-based metrics 25.2.4 Role of population health 25.2.5 Accountable Care Organization’s information technology needs 25.2.6 Potential role of Health Information Exchanges for Accountable Care Organizations 25.3 Role of Maryland’s Health Information Exchange in value-based care 25.3.1 Background 25.3.1.1 Mission and history 25.3.1.2 Types and number of stakeholders 25.3.1.3 Governance 25.3.1.4 Information flow and architecture 25.3.2 Maryland all-payer waiver program and CRISP 25.3.3 CRISP’s population health IT services 25.3.3.1 Hospital readmission reporting and prediction 25.3.3.2 Population health management services 25.3.3.3 Other ongoing or planned population health services 25.4 Conclusion/summary Questions for discussion References 26 Health information exchange—the value proposition: a case study of the US Social Security Administration 26.1 Introduction 26.2 Theoretical models for examining the value of health information exchange 26.2.1 Socio-technical systems approach 26.2.2 Interorganizational systems 26.2.3 Value proposition 26.2.4 Conceptual framework 26.3 Background and context 26.3.1 Nationwide Health Information Network 26.3.2 MedVirginia/Bon Secours1 26.3.3 US Social Security Administration 26.4 Case study 26.4.1 The challenge 26.4.2 Opportunity 26.4.3 The case: examining social versus economic value propositions 26.4.4 The case: examining the blended value collaboration enactment framework 26.4.5 Social Security Administration 26.4.6 MedVirginia 26.4.7 ONC 26.4.8 The Sequoia Project/eHE—an update 26.5 Summary Questions for discussion References 27 Health information exchange–enhanced care coordination: implementation and evaluation of event notification services in ... Major themes 27.1 Introduction 27.2 Background 27.3 Event notification 27.4 Context 27.4.1 Overview of the two Veterans Health Administration medical centers 27.4.2 Health information exchange in the Veterans Health Administration 27.4.3 Strengths and weaknesses of existing health information exchange in the Veterans Health Administration 27.5 Implementing event notification services in the Veterans Health Administration 27.5.1 Our community-based health information exchange partners 27.6 Experiences and lessons learned 27.6.1 Characteristics of Veterans with non-Veterans Health Administration care 27.6.2 Impact of event notification services alerts on timely follow-up 27.6.3 Impact of event notification services alerts on hospital usage 27.6.4 Impact of event notification services alerts combined with a care transitions intervention 27.6.5 Barriers to using event notification services 27.6.5.1 Contents of the event notification services alert message 27.6.5.2 Logging into the health information exchange network 27.6.5.3 Capacity concerns around scaling event notification services 27.6.6 Recommendations for future event notification services development and implementation 27.6.7 Use of event notification services to support COVID-19 response within Veterans Health Administration 27.7 Future directions for event notification services 27.8 Summary Questions for discussion References 28 Facilitating HIE in Denmark: the story of MedCom, a Danish health information organization Major themes 28.1 Introduction 28.2 Background 28.2.1 Denmark 28.2.2 The Danish health system 28.2.3 Digital health in Denmark 28.3 Health information exchange in Denmark 28.3.1 Digital health infrastructure 28.3.2 Security and user authentication 28.3.3 A pragmatic approach to engineering HIE solutions 28.3.3.1 View only 28.3.3.2 Messaging 28.3.3.3 Deep integration 28.3.3.4 Value proposition 28.4 HIE adoption and use 28.5 Keys to success for Denmark 28.5.1 Supportive health policy 28.5.2 Innate desire to achieve consensus and build community 28.5.3 MedCom the white hat organization 28.6 Challenges and barriers to HIE and data use 28.6.1 Failed efforts at interoperability and HIE 28.6.2 Using data for research and quality improvement 28.6.3 Limited awareness of HIE and multiple channels for access can equal confusion 28.7 Future directions 28.7.1 Setting Denmark on FHIR 28.7.2 Quality reporting for specialty providers 28.7.3 Enabling notifications for data harmonization 28.7.4 Care coordination 28.7.5 Saving and parsing discharge summaries 28.7.6 Electronic patient data suitcases 28.8 Summary Questions for discussion References 29 Addressing data needs for national HIV programs using HIE: case studies from Ethiopia and Nigeria Major themes 29.1 Introduction 29.2 Background 29.2.1 Working toward adoption of health information exchange in countries 29.2.2 Health information exchange and global human immunodeficiency virus program data needs 29.2.3 Key health information exchange technical considerations 29.3 Case studies 29.3.1 Case Study 1 Establishing a HIV viral load data exchange through an HIE in Ethiopia 29.3.1.1 Background 29.3.1.2 Viral load request and return of results before health information exchange 29.3.1.3 Viral load data exchange using health information exchange 29.3.1.4 Development and implementation process 29.3.1.5 Challenges 29.3.2 Case Study 2 A National Data Repository as the enterprise data store in an HIE in Nigeria 29.3.2.1 Background 29.3.2.2 Data exchange 29.3.2.3 Development and implementation process 29.3.2.4 Barriers and enablers in the health information exchange implementation 29.3.2.5 Monitoring health information exchange and future plans 29.4 Summary Discussion questions Disclaimer References 30 Health information exchange in Taiwan: multiple layers to facilitate broad access and use of data for clinical and popul... Major themes 30.1 Introduction 30.1.1 The Republic of China (Taiwan) 30.1.2 Taiwan’s health system 30.2 Background on Taiwan’s national health insurance system 30.2.1 Enrollment and universal coverage 30.2.2 Financing and administration 30.2.3 Accessibility and comprehensive coverage 30.2.4 Information technology 30.2.5 Information systems management 30.3 Health information exchange to support the NHI 30.3.1 The NHI IC card network 30.3.2 The NHI MediCloud System (NHI-MCS) 30.3.3 EEC health information exchange 30.3.3.1 Organization 30.3.3.2 Regulation 30.3.3.3 Stakeholders engagement 30.3.3.4 Technical approach 30.3.3.4.1 EEC HIE structure 30.3.3.4.2 Evaluation and subsidization of the EMR uploads 30.3.3.4.3 Content and semantic standards 30.3.3.4.4 Gateway installation environment requirements for the EEC 30.4 Security and privacy across the NHI system 30.4.1 Security 30.4.1.1 Electronic signature and access control 30.4.2 Privacy 30.5 Comparison of the NHI IC Card, Medi-Cloud, and EEC HIE Networks 30.6 Results and lessons from two decades of HIE in Taiwan 30.6.1 MediCloud network impact 30.6.2 EEC network utilization and performance 30.6.3 Facilitators of HIE in Taiwan 30.6.3.1 Universal health access and identifiers 30.6.3.2 Policy and breadth of data that compels use of HIE network 30.6.3.3 Engagement of consumers in HIE access 30.6.4 Barriers and lessons learned 30.7 Future directions 30.7.1 Using services online by virtual NHI IC card 30.7.2 Using NHI cloud technology to tackle pandemic 30.7.3 Building up systemwide interoperability 30.7.4 Evolving standards to FHIR 30.7.5 Incentivizing provider use of EEC 30.8 Summary Discussion questions References 31 Israel’s national HIE network Ofek: a robust infrastructure for clinical and population healt

Health Information Exchange (HIE): Navigating and Managing a Network of Health Information Systems allows health professionals to appropriately access, and securely share, patients’ vital medical information electronically, thus improving the speed, quality, safety, and cost of patient care.

The book presents foundational knowledge on HIE, covering the broad areas of technology, governance, and policy, providing a concise, yet in-depth, look at HIE that can be used as a teaching tool for universities, healthcare organizations with a training component, certification institutions, and as a tool for self-study for independent learners who want to know more about HIE when studying for certification exams.

In addition, it not only provides coverage of the technical, policy, and organizational aspects of HIE, but also touches on HIE as a growing profession. In Part One, the book defines HIE, describing it as an emerging profession within HIT/Informatics. In Part Two, the book provides key information on the policy and governance of HIE, including stakeholder engagement, strategic planning, sustainability, etc. Part Three focuses on the technology behind HIE, defining and describing master person indexes, information infrastructure, interfacing, and messaging, etc. In Part Four, the authors discuss the value of HIE, and how to create and measure it. Finally, in Part Five, the book provides perspectives on the future of HIE, including emerging trends, unresolved challenges, etc.

• Offers foundational knowledge on Health Information Exchange (HIE), covering the broad areas of technology, governance, and policy
• Focuses on explaining HIE and its complexities in the context of U.S. health reform, as well as emerging health IT activities in foreign nations
• Provides a number of in-depth case studies to connect learners to real-world application of the content and lessons from the field
• Offers didactic content organization and an increasing complexity through five parts

Health Information Exchange is an increasingly important discipline within the larger field of health information technology / informatics. To support health care professionals in managing the array of information available about patients and populations, health systems have adopted and continue to incorporate a variety of information and communications technologies (ICT) into the delivery and administration of health care. Although electronic health record (EHR) systems and other forms of health ICT have been demonstrated to be effective at improving health care delivery and outcomes, isolated ICT systems cannot maximize benefits, because health care delivery occurs within the context of a highly complex system. The purpose of this book is to provide a robust description of HIE, its various forms, its technical design, its governance, and its use around the world. Because HIE is critical to the success of health care improvement in the U.S. and abroad, the book aims to inform those in clinical practice, health care administration, public health, and information technology about HIE and its role in supporting health systems. Key Features, Offers foundational knowledge on Health information Exchange, covering the broad areas of technical design, implementation, adoption, governance, and policy, There is no other comprehensive book that covers the full range of HIE development, adoption management, and evaluation / research, The content is perfect for students and professionals in health informatics, information management and ICT who desire to explore the range of issues and trends impacting HIE, as the field of health care moves forward with the adoption and use of ICT systems, Covers a number of key competencies and core content areas required for the medical subspecialty of Clinical Informatics Health Information Exchange (hie): Navigating And Managing A Network Of Health Information Systems Allows Health Professionals To Appropriately Access, And Securely Share, Patients' Vital Medical Information Electronically, Thus Improving The Speed, Quality, Safety, And Cost Of Patient Care. The Book Presents Foundational Knowledge On Hie, Covering The Broad Areas Of Technology, Governance, And Policy, Providing A Concise, Yet In-depth, Look At Hie That Can Be Used As A Teaching Tool For Universities, Healthcare Organizations With A Training Component, Certification Institutions, And As A Tool For Self-study For Independent Learners Who Want To Know More About Hie When Studying For Certification Exams. In Addition, It Not Only Provides Coverage Of The Technical, Policy, And Organizational Aspects Of Hie, But Also Touches On Hie As A Growing Profession. In Part One, The Book Defines Hie, Describing It As An Emerging Profession Within Hit/informatics. In Part Two, The Book Provides Key Information On The Policy And Governance Of Hie, Including Stakeholder Engagement, Strategic Planning, Sustainability, Etc. Part Three Focuses On The Technology Behind Hie, Defining And Describing Master Person Indexes, Information Infrastructure, Interfacing, And Messaging, Etc. In Part Four, The Authors Discuss The Value Of Hie, And How To Create And Measure It. Finally, In Part Five, The Book Provides Perspectives On The Future Of Hie, Including Emerging Trends, Unresolved Challenges, Etc. Edited By Brian E. Dixon, Mpa, Phd, Fhimss. Includes Bibliographical References And Index. Mode Of Access: World Wide Web.