Introduction
Succinctly, health information exchange (HIE) is the process where patients’ information are transmitted electronically between providers and organizations which deal with healthcare provision. The agenda is to offer remedy to the present fragmentation of health information ( Vest et al., 2011 ). The quality and efficiency of healthcare delivery can be improved by such interoperability enhanced by HIE ( Esmaeilzadeh & Sambasivan, 2017) . Esmaeilzadeh & Sambasivan (2017) assert that patients’ management through HIE has been championed over the past few years and major advancements have been witnessed in this field. HIE has greatly been influenced by the meaningful use program and the Health Information Technology for Economic and Clinical Health (HITECH) Act ( Esmaeilzadeh & Sambasivan, 2017) . This paper aims to explore the functionality of the health information exchange in addition to the benefits attained from both regional and local exchanges in promoting healthcare delivery and continuity of care in patients’ management.
Functionality of Health Information Exchange
Health information exchange between stakeholders is championed by different federal states such as US and Australia. The meaningful use program initiated by the US government is geared towards promoting adoption of Electronic Health Records with the aim of encouraging exchange of information pertaining to patients’ healthcare ( Esmaeilzadeh & Sambasivan, 2017) . The application of interoperable health information technology (HIT) was promoted so as to permit HIE in the delivery of healthcare. The US government in 2009 passed the HITECH Act so as to officially fund the implementation of HIE through HIT ( Esmaeilzadeh & Sambasivan, 2017). Nevertheless, various impediments to full implementation of HIE have been cited ranging from organizational issues to technological challenges in addition to political obstacles (Vest et al., 2011).
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Notably, HIE is a continuum of healthcare services fashioned to permit accessibility of patients’ information to the relevant stakeholders only with an objective of upholding and preserving patients’ right and welfare (Frisse et al., 2011). Frisse et al (2011) established that HIE is achievable through services offered by various health information organizations in addition to direct linkage between healthcare professionals. However, a major challenge surrounds coordination of information between various stakeholders owing to concerns relating to security, safety, operation and legality. Furthermore, patients are the major stakeholder in these operations since usage of their information necessitates their consent ( Esmaeilzadeh & Sambasivan, 2017). Patel et al. (2012) as cited in Esmaeilzadeh & Sambasivan (2017) assert that two major variables influences patients’ support of HIE, that is, probable benefits, and security and privacy apprehensions relating to HIE. Exchange of information include manually fixed exchange or “point-to-point messaging or automated query-based health information exchange (HIE), and aggregating data from multiple sources” ( Campion et al., 2013 ).
Benefits
HIE as part of HIT is designed to enhance transmission of patients’ information electronically in the course of healthcare delivery in various institutions. Numerous benefits are promised by the adoption of HIE; these include improvement in healthcare quality, efficacy and safety. Notably, the most critical and beneficial effects of HIE relates to improved dissemination of information among physicians during healthcare delivery, attainment of accurate and complete medical records, and most importantly increased safety in the management of patients ( Esmaeilzadeh & Sambasivan, 2017) . In public health, HIE has the potential of being applied in tracking non-communicable diseases as well as detecting communicable diseases at their early stages, thus promoting the overall quality of health and saving lives. Moreover, HIE is rather convenient since it expedite service delivery through data sharing and allowing for reduction in bills relating to healthcare. ( Esmaeilzadeh & Sambasivan, 2017) .
The benefits attained through HIE extends beyond in-patients services. Other beneficiaries other than patients include private physicians in various satellite offices, pharmacists, radiologists, laboratory technologists, providers in nursing homes and clinics, and personnel in health departments. Data that could not be accessed is now made available through HIE with resultant cut down in cost in terms of billions (Vest et al., 2011). Costly medical errors have significantly been reduced with improvement in quality of care through access established under the HIE platform. Clinicians are able to obtain medical records from different sites of care thus better continuity of care. Frisse et al. (2011) established a significant reduction in the financial cost of running an emergency departments (EDs) upon implementation of HIE. It was estimated that a net of $1.9 million was saved in the EDs through the application of HIE ( Frisse et al., 2011).
Patient Continuity of Care
The major impediment to continuity of care for patients in the US is fragmentation of health information within the healthcare delivery system. The critical point of vulnerability with regards to medical errors is the time of transitions of care. Major discrepancies surrounding medication are witnessed at this point. Lack of HIE accounts for the gaps in the patient continuity of care . Patients’ safety and continuity of care is threatened by absence of past medical history, laboratory results and current medication or plan of treatment ( Campion et al., 2013 ) . Good news is that HIE has the capabilities of alleviating these problems ( Campion et al., 2013 ). Access to patients’ medical records can be enhanced through HIE across boundaries within and without the organization, both locally and regionally. Campion et al. (2013) established that automated query-based HIE has the capabilities of supporting continuity of care through effective sharing of information at the time of transition and can aid US professionals in attaining stage two of meaningful use. HIE is instrumental when continuity of care is necessary given the linkage and coordination offered in the process.
Level of Adoption
In spite of the benefits accrued from HIE systems, utilization of this HIT is rather limited, often used by few providers. This is so despite the efforts spearheaded towards improving exchange of health records (Vest et al., 2011). According to the study by Adler-Milstein, Bates & Jha (2011) only 75 regional health information organizations (RHIOs) were operational out of the 197 accounting for about fourteen percent of the hospitals in US and three percent of ambulatory practices. Notably, stage 1 meaningful use was supported by only 13% RHIOs accounting for three percent of hospitals and 0.9 percent of the ambulatory practices. Nonetheless, definition of a comprehensive RHIO was not met by any of the centers. Concerns have been raised whether RHIOs in their present state are capable of assisting hospitals and doctors in implementing efficient HIE needed in improving quality of healthcare (Adler-Milstein, Bates & Jha, 2011).
According to the recent longitudinal survey by DesRoches et al. (2013), only forty-four percent of hospitals in US have fully adopted and implemented the basic electronic health record (EHR) system. Furthermore only 5.1% have met the stage 2 meaningful use. Stage 1 meaningful use has been met by only 42.2% (DesRoches et al., 2013). The rate of adoption of EHR system is more pronounced among teaching hospitals and those located in urban centers as opposed to nonteaching hospitals and those in rural set-up.
Conclusion
As outlined herein, health information exchange is vital in promoting quality of healthcare and efficiency. Its valuable effects in the continuity of care cannot be overemphasized. Attempts have been made by federal states to support HIE through various incentives. Nevertheless the level of adoption seems to be below fifty percent despite the many benefits of HIE.
References
Adler-Milstein, J., Bates, D. W., & Jha, A. K. (2011). A survey of health information exchange organizations in the United States: implications for meaningful use. Annals of internal medicine , 154 (10), 666-671.
Campion Jr, T. R., Vest, J. R., Ancker, J. S., Kaushal, R., & HITEC Investigators. (2013). Patient encounters and care transitions in one community supported by automated query-based health information exchange. In AMIA Annual Symposium Proceedings (Vol. 2013, p. 175). American Medical Informatics Association.
DesRoches, C. M., Charles, D., Furukawa, M. F., Joshi, M. S., Kralovec, P., Mostashari, F., ... & Jha, A. K. (2013). Adoption of electronic health records grows rapidly, but fewer than half of US hospitals had at least a basic system in 2012. Health Affairs , 32 (8), 1478-1485.
Esmaeilzadeh, P., & Sambasivan, M. (2017). Patients’ support for health information exchange: a literature review and classification of key factors. BMC medical informatics and decision making , 17 (1), 33.
Frisse, M. E., Johnson, K. B., Nian, H., Davison, C. L., Gadd, C. S., Unertl, K. M., ... & Chen, Q. (2011). The financial impact of health information exchange on emergency department care. Journal of the American Medical Informatics Association , 19 (3), 328-333.
Vest, J. R., Zhao, H., Jaspserson, J., Gamm, L. D., & Ohsfeldt, R. L. (2011). Factors motivating and affecting health information exchange usage. Journal of the American Medical Informatics Association , 18 (2), 143-149.
