Anyone who has experienced the health care system knows there isn’t enough information sharing. Your medical history is typically regurgitated every place you go, usually by you via paper forms. Over and over again. A health information exchange (HIE) can alleviate some of that hassle. In the simplest terms, an HIE solution is infrastructure that coordinates the movement of clinical data to the appropriate care setting. HIE is not a workflow; it is data orchestration. An analogy often used is that HIE is plumbing and the user workflows are the shower heads, faucets, etc. It ensures appropriate information is available at the time it’s needed. Providers use HIEs for efficient movement of clinical information among other providers.
One major benefit health care facilities gain in leveraging an HIE is patient safety. Think of a doctor placing orders in their electronic health record (EHR) system. Orders for medications and lab work could potentially cause harm, depending on their combination. We wouldn’t dream of having a system that didn’t check for potential harmful effects between medications. But, clinicians experience this blindness every day. For example, if I’m allergic to a certain kind of drug that isn’t recorded in my physician’s EHR and the drug is ordered, I’ll have an allergic reaction. Without an HIE, the system of checks and balances in patient safety isn’t available in all care settings.
The most significant benefit to clinicians is providing the patient’s full story to make better, more informed decisions. A doctor wouldn’t order a medication if he knew the patient was allergic. The doctor’s local EHR can provide that information. But there isn’t a system that’s going to tell a doctor at a clinic down the street that same vital information. Clinicians have to rely on patients to share that information. The more complex the patient and their treatment, the higher the risk.
HIEs vary, depending on care venues and business needs. If a health system uses multiple suppliers, it may need more infrastructure to be connected, no different than what interface engines have historically done. If it’s a single EHR solution in place, a connection to a national network may be all that’s needed. One way to think of this is the analogy of using an internet or an intranet. A health system may have its own “intranet” for internal data sharing that it secures and governs. However, once a health system wants to go to the “internet,” to share information outside of its system, they have to confine to standards and governance of these broader networks. The needs of the health care organization will dictate the kind of HIE infrastructure needed.
I anticipate national networks, such as CommonWell, will continue to expand over the next several years. CommonWell removes the enterprise, geographical and business competitiveness that can get in the way of universal data sharing. We need national infrastructure to do that. Other exchanges – local or regional HIEs – have a hard time scaling to that kind of expectation.
We joined with our competitors in the creation of CommonWell in 2013 to advance that national infrastructure. It’s going to be a long and difficult road to complete that goal. We understand it’s not going to happen overnight. It’s not just a Cerner problem; it’s a big and difficult industry problem, but we are committed and determined to solving it. There are no alternatives.