Sharing Data in Collaborations

March 2016

A recipe for interoperability and HIE in rural health networks

By Joe Wivoda, CIO, Rural Health Innovations

Interoperability and health information exchange (HIE) are important aspects of health information technology. Interoperability is a key focus for many networks and for the Office of the National Coordinator for HIT (ONC).

To be able to exchange health information with other vendors (e.g., your referral partners), it takes more than getting your vendor to play well with other vendors. That can certainly be a challenge, but there is emerging a best-practice set of steps to follow.

This health information exchange “recipe” will improve your chances of making real improvements in patient experiences and care. Keep in mind that the steps below do not necessarily happen sequentially; many times, they are performed in parallel.

Step 1: Develop clear use cases that demonstrate the value of exchange

Use cases are important in solidifying your strategy for exchange. By having clear use cases, you can clearly communicate the value of exchanging patient information electronically. Further, a good use case can provide a clear path toward technology selection and implementation.

Step 2: Consider any privacy and security barriers

Privacy and security of patient information is a must, but there can be additional challenges due to the use cases developed earlier. For example, if you are hoping to exchange information with school-based nursing services, you will need to understand requirements of the Family Educational Rights and Privacy Act (FERPA). Likewise, if your use case involves referrals from primary care to behavioral health, then you will need to understand how state and federal regulation of substance abuse information (42 CFR Part 2 in particular) may affect your project.

Step 3: Understand your referral partners and their capabilities

Your use cases should define who the referral partners will be, but you should rely on data as much as possible. Too often when I ask hospitals who they refer patients to, I get a knee-jerk response of “the large tertiary hospital in an urban center a short helicopter ride from here.”

When the hospital runs a report to look at where patients are discharged to, they learn that the local primary care clinic, long-term care facility, and homecare are the primary referral partners. These partners may not have electronic health records (EHRs) that can connect to an HIE, for instance, and you may need to make sure that whatever solution you use can support portal access.

Step 4: Establish data governance procedures early on

Data governance is important for managing the availability, usability, integrity, and security of data. Data governance becomes especially important when multiple organizations are sharing data and storing it centrally. Data governance should define how data is stored and shared, but also how it will be protected.

Step 5: Obtain use agreements with all partners

Data governance decisions will lead to the policies and procedures around the storage of data, but data use agreements with all partners are also necessary. These data use agreements can be complex and need to be standardized among partners.

Step 6: Implement the technology

Again, your technology solution should be driven by your strategy. That strategy will be dictated by the use cases that are important to your network. Further, your technology solution should allow for an incremental approach, so that you can build on small gains and create your own momentum.

The lack of demonstrated value for HIE has been a stumbling block, and usually that lack of value is due to a vision that requires complete HIE functionality. For example, having a centralized data repository with complete health information available for patients in a region would be great, except it requires significant investment and a critical mass of providers (and patients) to sign up before it has value. Using Direct Secure Messaging to send health information upon patient transfer is cost-effective and can be done with two providers. Consider using incremental approaches to build a value proposition.