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1.0 Definition of Health Information Exchange (HIE)
Health Information Exchange (HIE) refers to the coordinated electronic transfer of the highly organized healthcare information among governmental healthcare providers, independent health information organizations and other health facilities. According to John Hanns (2008) in his latest publication, “The Modernization and Development of Healthcare Services in U.S”, HIE remains the most important component of the modernized healthcare information technology infrastructure across the United States of America. The information technology oriented healthcare program is part and parcel of the greater National Health Information Network.
The structural components of the HIE technology are made is such as a way that it guarantees accurate and reliable transmission of data within the integral healthcare system for easy access and retrieval. The main objective of HIE is to increase the efficiency of healthcare services delivery through coordinated gathering of all the required information by the healthcare users concerning their clients.
2.0 History of Health Information Exchange (HIE)
Although integrated health information system became the top agenda in the National Healthcare Reforms form early 1990s, no tangible development was realized until 2001 when the idea of the Health Information hatched within the U.S public healthcare system. According to Professor Hanns (2008), “the urgency of the matter came up only after the 9/11 Al-Qaida terrorist attack amidst the fears of anthrax and SARs attacks on the American citizens” (p. 137). In bid to improve surveillance against the imminent external terrorist attacks, the American President, George Bush, formed an Office of the National Coordinator of Health Information Technology (ONCHIT). The President appointed Dr. Brailer as the head of the big Office.
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At the time of its formation, ONCHIT was charged with the task of detecting and counteracting any deadly epidemics such anthrax, SARs, and Avian Flu across the United States of America. This mandate prompted the coordinator’s office to develop electronic health information data on every American citizen. As U.S citizens move across different states, “their health status could be retrieved from the elaborate system to ascertain whether they are free from the most dreaded contagious epidemics or not” (Hanns, p. 142). This marked the beginning of the health information technology that later turned into Health information exchange.
In his capacity as the head of Office of the National Coordinator of Health Information Technology, Dr. Brailer ordered for the further inclusion of additional personal health information besides SARs and Anthrax. Given the elaborate technological infrastructure and detailed data of every America citizen in the system, ONCHIT adopted the much desired efficient National Health Information Network (NHIN) which facilitated a possible transfer and subsequent exchange of health information between different healthcare providers across the United States. From that time, both primary and secondary healthcare providers can freely transfer and exchange health related data amongst themselves.
3.0 Benefits of Health Information Exchange
From the time of its inception to date, HIE has yielded a lot of benefits in the public health sector in regard to its efficiency and effectiveness. Several health facilities and secondary healthcare providers have increased their annual productivity and profitability. Likewise, patients are pleased with the high quality of healthcare services they get due to the implementation of integrated health information technology. This section discusses the benefits healthcare stakeholders enjoy from the centralized HIE in the United States of America.
3.1 Easy Maintenance and Management of Personal health Records
Before the introduction of the HIE, it was never easy to maintain every individual’s clinical records particularly when the client (patient) was served by multiple healthcare service providers HIE makes it possible to electronically transfer all the bits of clinical information of an individual entity from all points of medication to a centralized information centre where they are organized into data, stored in appropriate portfolios, and can be retrieved at any given time.
According to Gary Mellin (2009), a medical expert and a researcher at the Institute of Tropical Infections, Massachusetts, HIE is lauded for the shortest time it makes it possible to retrieve relevant clinical data on any individual entity. In her publication, “revolutionarized healthcare service providers”, the author acknowledges the efficiency of the centralized health information system. In her words, “You no longer need to move from one health facility to another collecting data from the old torn file records dumped together in some metallic cabins… things are made easy. Information is highly organized, very sensible and it is great fun to retrieve from the computerized system” (p. 24). This is one element that speeds up the provision of medical services to clients.
3.2 Safety of the Health Information
Virtually, all the portfolios of the health data stored in the system cannot be lost because there is adequate back up unlike the physical records that are more susceptible to fire, misplacement, and loss. Most importantly, all the individual clinical information in HIE system are protected against unauthorized access by any other person- otherwise referred to as the hacker in this matter. Access to the electronic Health Information is restricted to the licensed practicing medical personnel and registered Medicare insurance companies.
3.3 Accurate Public Health Planning
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The biggest milestone ever achieved by the HIE is improved public health planning by both the U.S States and Federal Governments. The public health authorities extensively analyze data retrieved from the system to assess the health of the entire population for instance the most prevalence disease, percentages of various categories of infections, regional and state health analysis, and establish current trends of various epidemics. In this way, healthcare experts find it possible to plan for the effective provision of healthcare services depending on the regional needs of citizens across the United States of America.
3.4 Improved Patient Care
HIE systems readily avail all the required medical history about a selected patient including all the details such as prescriptions, clinical diagnosis, medical assessment results, and patient’s response to various drugs. These sets of information are very useful in the continuity of patient’s care particularly in the case of multiple healthcare providers because they can easily trace the periodic medical history of a patient.
HIE generally enables all the medical practitioners within the healthcare system to offer excellent patient care with minimal constraint simply because most of the historical information about the individual patient’s previous medications, any allergy to some group of medicine, clinical results and the most current health status are at their disposal. Owing to the fact the HIE system keep track of all the clinical medications given to patients, the medical practitioners are always under an obligation to meet high standards of care they provide to patients. “Cases of misdiagnosis and wrong medication are consequently reduced by HIE to mere 0.5%” (Gary, p. 78).
Thirdly, HIE reduced the operational cost of primary and secondary healthcare by 30% in U.S. The faster and reliable electronic exchange of clinical information between health facilities and other secondary healthcare providers eliminates all the unnecessary subsequent routine clinical procedures such as repeated medical diagnosis, duplicate tests, and confirmatory x-ray and scans. All these information are available in the HIE system. Initially, such clinical confirmatory tests would cost an average of $23,000 per annum (U.S Healthcare Records 2008). Patients are equally relieved of keeping and carrying medical records, referrals and clinical test results whenever they seek medical attention.
4.0 Privacy and Security Concern
Even though HIE remains the greatest technological breakthrough of the 21st century in the U.S healthcare system, there is an increasing concern for the privacy and security of the confidential information. Considering that personal health information is confidential and no any other party is entitled to have direct access unless authorized by the patient, the HIE system compromises this privacy since it is open to all categories of healthcare providers (undesired feature of the system that grossly violate patients’ constitutional rights).
In the year 2008, more than two thousands cases of fraudulent retrieval and subsequent uses of confidential health records were reported to the U.S Metropolitan in various states; the total number of reported cases increases to four thousand seven hundred cases in 2009. From the statistics, the trend of illegal uses of health information from the HIE system is on the increase. An interview conducted in U.S in January 2009 revealed that 43% of the American citizens are happy with the HIE; and 57% are upset that their personal clinical records are posted on the HIE system for uncontrolled use by the third party.
In bid to counteract the above mentioned challenges of the HIE, the U.S federal Government is currently enacting bills that would govern and regulate operations of the Health Information Technology and HIE. The only existing regulation relevant to this function is called “The Meaningful Use” that provides guidelines to all categories of HIEs on how to protect privacy and safety of the personal health information data. Similarly, the regulation not only call for the professional and ethical handling of data within the HIE systems but it stipulates the possible penalty for the breach of its rules.
5.0 Current Challenges Facing HIEs and Suggested Solutions
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The leading problem experienced by the HIEs is the limited funds necessary for the expansion of its technological infrastructure over a wider geographical coverage. Inadequate funding remains the biggest stumbling block for anticipated expansion of the HIEs in all States of the U.S. For this reason, the centralized electronic data represent just a fraction of the entire American population most of whom reside in the developed counties such as Indiana. To increase the reliability and inclusiveness of the HIEs, the States and Federal governments should allocate more funds for the expansion of HIE infrastructure across the United States.
The presence of independent mushrooming HIEs in different states of the United States also compromises the safety and security of the heath information data because they operate on the basis of their own selfish interests. To regain lost public confidence in the HIEs, the Federal government must ensure that only licensed HIEs remain in the sensitive business after which a powerful supervisory board, similar to National Health Information Network, will be constituted to oversee their (licensed HIEs) operations from time to time.
6.0 Conclusion and Recommendations
In conclusion, Health Information Exchange (HIE) is the transfer of electronic clinical information into a centralized system for general use by other health facilities, governmental health agencies as well as other independent Health Information Organizations. From the time of its inception to date, HIE has yielded a lot of benefits in the public health sector in terms of its efficiency and effectiveness. Several health facilities and secondary healthcare providers have increased their annual productivity and profitability on one hand and patients are also pleased with the quality of healthcare on the other hand.
Major challenges that affect the HIE is the compromised privacy and security of the much sensitive clinical health information transferred into the system. The HIEs should be restricted to avail such information to the third party only with the approval of the system administrator. Secondly, the Federal government should provide more funds and grants for the expansion of the HIE technological infrastructure.
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