Tuesday, November 16, 2010

Clinical, Technical and Policy Issues in Exchanging Health Information

Every once in a while we get a request by a reader to post a guest entry on the blog. Frankly, we remain a bit dubious. But they are so eager, we allow the better angels of our otherwise controlling nature some free rein. So, here is a guest post for your interest and enjoyment.  Many thanks to author Rachel Davis who more often writes on Radiology degrees . She welcomes your comments at racheldavis65[@]gmail[.]com.

Clinical, Technical and Policy Issues in Exchanging Health Information
Health Information Exchange (HIE) has been proposed as one of the best ways to reduce waste and bring down costs in the healthcare system – when patient information is shared electronically across disparate healthcare systems without compromising on security, meaning and accuracy, it enables optimal provision of health care. For HIE to achieve success and attain its goals, the clinical, technical and policy issues relevant to the exchange of health information must be defined clearly and followed accurately.
Clinical issues are those that relate directly to patient care and which facilitate the provision of effective care in the shortest possible time and at the least possible cost. A study conducted by the Medical College of Wisconsin has found that ER doctors who have electronic access to patient data through a HIE spend less time in gathering information and make clinical decisions that are better informed and lead to better care for the patient. Clinical issues of a HIE deal with the accurate collection and compilation of information such as lab procedures, prescribed medication, patients’ main complaints, prior visits and treatments, and any other data that helps the attending doctor gain a more comprehensive picture of the medical history of the patient. When clinical information is accurate, it prevents errors, reduces wastage of time, effort, and money, and eliminates redundancy – time and money are not wasted on tests that have already been done, and medicines that cause allergies and adverse reactions are not prescribed inadvertently. 
The technical issues relate to the software and hardware requirements for the implementation of the HIE. The underlying architecture of the HIE must be designed and implemented, and it should include information relating to medication history standards, laboratory result standards, issues that relate to data quality, and the implementation of a record locator service.
Policy issues relate to the privacy aspects in a networked HIE, privacy policies and procedures that relate to a HIE, notification and consent when using a record locator service, matching patients to their records correctly and without any mix-ups, authenticating and setting levels of access for users, deciding on patient access to their own information (and protecting information of other patients), auditing access to a HIE, breaches of confidential health information, and a common and standardized framework for networked personal health information.
A Health Information Exchange must resolve clinical, technical and policy issues before it can be implemented successfully in any healthcare setting.


  1. This is great. People in the field of medicine should observe this to understand the rules of exchanging information on health issues.

  2. In Michigan our largest HIE has decided to go with the patient opt-out policy on participation. The only problem is that most patient do not understand that any provider on the network that has authorized access can review their medical record. Here is an example were the healthcare industry has determined that patient privacy takes a back-seat to their convienence. Now what the HC industry will tell you is that they are protecting the patient. They also state that their auditing process will randomely audit access logs, but working in the HC industry for over 25 years, I will inform you that self reporting HIPPA violoations happen less than 10% of the time.

  3. Anonymous is quite right that anyone with authorized access can see the data. I don't know the rules for this particular HIE, but it is incumbent on them to make sure that only legitimate providers can see it. Given that, I feel that the strengths and benefits of a passive opt-out policy far exceed the risks and weaknesses. That is not to say the downsides are zero, but I do believe the trade-off is highly favorable for most patients.


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