Why Health Information Exchange is Important for EHR Use

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Why Health Information Exchange is Important for EHR Use

Health Information Exchange is Important for EHR Use

Electronic Health Records (EHRs) are an integral part of today’s healthcare system. Despite initial hesitation to switch to an EHR, an overwhelming majority of organizations that have made the change cannot imagine going back to paper. EHRs improve efficiency and increase reimbursements while improving patient care. As providers become more fluent with the technology, EHRs help them with decision making and influence the way a client is treated. Additionally, EHRs enable connectivity, or to use the current buzzword, interoperability.

Interoperability refers to health information technology that enables electronic health information to be easily exchanged. It lets authorized professionals access, exchange and use the health information. In our journey to transform healthcare, Health Information Exchanges (HIEs) have been established. Connecting an EHR to an HIE allows health information to flow seamlessly to the right people at the right place at the right time.

What is an HIE?

But what exactly is an HIE? Historically, when a patient visited a healthcare facility, the provider had two paths to understand the medical history of the patient:

  • Check the facility’s own EHR system for prior visit information, such as allergies, medications, procedures, etc.
  • Ask the patient to fill in any missing information not already documented.

As you know, there are several problems with this process. Not only do patients rarely remember information from prior visits, but they are seen in multiple facilities using various EHR systems, as well. Also, consider a patient who comes into the ER and is unresponsive. How would a provider find out about his or her missing information?

A Health Information Exchange addresses this issue. An HIE is a secure central repository of patient data aggregated across multiple facilities and EHR systems in the same region. The goal is to provide a holistic view of the patient’s electronic health record through a secure, standardized system. EHRs connected to an HIE can share information via the federally defined standards of CCR (Continuity of Care Record) and CCD (Continuity of Care Document). This is the standard all federally-certified EHRs must follow.

Any federally-certified EHR connected to an HIE can (if permitted) send and/or receive information between the EHR and the HIE. Thus, the provider can send and receive electronic information with any community provider also connected to the HIE.

Benefits of Health Information Exchange

Benefits of Using an EHR for Health Information Exchange

Using an HIE streamlines information and connects a practitioner to all aspects of a client’s medical history. Practitioners can receive health information from the HIE, such as a patient discharge summary from a community hospital. This information can be brought into a patient’s chart as electronic health data after it has been reviewed. Using an HIE helps facilitate coordinated patient care, enabling an organization to:

  • Save time by minimizing readmissions
  • Increase efficiency by moving away from paper and fax machines
  • Save money by avoiding duplicate testing
  • Provide clinical decision support tools to improve care and treatment
  • Minimize medication and medical errors
  • Engage consumers about their own personal health information
  • Improve healthcare quality and outcomes.

HIEs reduce the amount of time patients spend completing paperwork and briefing their providers on their medical history. This frees up more time for discussions about health concerns and treatments between the patient and provider. By saving time for patients and providers along the continuum of healthcare delivery, HIEs have the potential to both reduce costs and improve health outcomes.

Health Information Exchange Challenges

The push for nationwide interoperability and improved health data exchange have increased HIE and EHR use. In some cases, organizations have been mandated to make the adoption. But, that doesn’t mean HIE connectivity doesn’t come without challenges.

HIE and Data Security

One of the biggest concerns with HIEs is ensuring health data privacy and security are maintained throughout the entire data exchange process. Participating organizations must follow all federal and state requirements related to data security, but they still need to allow information to be exchanged freely for patient care. While information exchange between EHR systems and HIEs is HIPAA compliant, the growing number of cybersecurity attacks have piqued concern about health data security.

A 2017 Black Book survey confirmed these fears extend to patients. Patients surveyed were nervous their digital health information might be shared beyond their physician and hospital. Furthermore, they are not confident their physician will be able to keep their personal information secure. 69% felt their primary care physician “does not demonstrate enough technology prowess” to reassure them that their data is safe.

Physician Burnout

Another major challenge HIE connectivity brings to the forefront is information overload. Physicians are already experiencing burnout. Providers are further burdened with copious amounts of data flooding them, which can lead to less effective care.

While the Patients Over Paperwork initiative is promising to reduce administrative burden and physician burnout, it doesn’t fully account for the volume of data providers will be faced with.

Many providers have lamented that their EHR system is not built with an easy to use clinical workflow. Adding another step to incorporate data from an HIE is just that – another step.

Regardless of the challenges, EHRs and HIEs aren’t going away. They are a major part of the digitization of healthcare and the shift toward value based care. Learning to utilize these tools effectively will help your organization provide more streamlined, effective patient care. And, of course, we recommend working with an EHR vendor who will help you navigate this process with training, support and best practices!



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What is HL7?

HL7, FHIRE and interoperability

As interoperability becomes a more pressing issue for providers, EHR vendors are paying attention to the standards that work to enable seamless health data exchange. Terms used frequently are HL7 and HL7 FHIR (which is pronounced “fire”), but many providers don’t really know what these things mean.

To start, what is HL7? Health Level Seven International (HL7) is an accredited standards organization. They focus on providing a framework and standards for the exchange, integration, sharing and retrieval of electronic health information. As an organization, their mission is to provide standards that empower global health interoperability. Their goal is to improve care delivery, optimize workflow and enhance knowledge transfer among healthcare providers, government agencies and patients, to name a few.  

HL7, FHIR and your EHR

HL7 Compliance

If your Electronic Health Record (EHR) solution is HL7 compliant, it means it conforms to the requirements of the standard. There are specific requirements an EHR software must meet. For example, the HL7 EHR Behavioral Health Functional Profile includes the functions and conformance criteria that is important for behavioral healthcare providers’ clinical records system. For providers, HL7 compliance tells them their EHR will work toward:

  • Improving the health of at-risk populations by improving care coordination between specialty behavioral health, primary care, and related human services providers, through systems interoperability
  • Improving provider performance accountability
  • Supporting emerging Accountable Care Organizations (ACOs)


HL7 FHIRE Bringing greater connectivity

HL7 Fast Healthcare Interoperability Resources (FHIR) is the next generation standard that provides a framework for interoperability. It’s designed to facilitate the exchange of electronic healthcare information (EHI) between organizations. It was created to make it easier to connect different healthcare data elements using a web-based approach. Using this framework, data elements will each have a tag that acts as a unique identifier, just like the URL for an individual web page.

By using the internet as a platform, users can access the same URL regardless of the type of device they’re using — Apple or Windows, smartphone or desktop. FHIR is aiming to do this for health information. Their goal is to enable developers to create applications that allow access to data no matter which EHR solution is being utilized.

Get Excited about FHIR

FHIR is exciting for both patients and providers because it will make healthcare information easier to utilize. Not only will it make the experience much more like other online experiences people are used to, but it will also make wearable devices more clinically relevant.

With FHIR, all kinds of health and wellness products — think fitbit, iHealth and an array of wearable medical devices — could theoretically tie into a patient’s EHR. Going one step further, this patient-generated health data could be parsed by another app that is built on FHIR and performs an analysis of the data. This analytical data would enable providers to access relevant patient-generated health information and use it in a way that could support the overall wellbeing of the patient.

From the patient perspective, FHIR aims to provide a single personal health record. So, rather than logging into portals for various providers, patients will be able to access a comprehensive record that shows all of their medications, diagnoses, health concerns, and more. Basically, a one-stop-shop for their personal health information.

What the Future Holds with HL7

With standards like this in place, it is easy to see the direction healthcare is going in. One that provides easy access to health information for both patients and providers. One that aggregates data to be a useful tool for supporting, and even predicting, health outcomes. One that brings healthcare to a point of truly delivering whole person care.




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What is Interoperability?

Interoperability with a Behavioral Health EHR

According to the 21st Century Cures Act, interoperability refers to health information technology that does three things. Firstly, it enables electronic health information to be easily exchanged. Secondly, interoperability allows authorized professionals to access, exchange and use the health information. Lastly, it does not allow for information blocking.

Benefits of Interoperability

The ultimate goal of interoperability, however, is not so technical. The technology is merely the tool. The goal is to empower patients and reduce administrative burden. Patients will be empowered because they’ll have better access to healthcare pricing information and improved access to their electronic health records. On the provider side, interoperability will reduce duplication, provide continuity of care, and make it easier to spend time with patients. Furthermore, improved communication between providers caring for the same patient enables providers to make more informed healthcare decisions and coordinate the care they provide.  

Beyond patients and providers, an interoperable health IT ecosystem will also support critical  healthcare functions. These include:

  • real-time case reporting
  • disease surveillance
  • disaster response

Additionally, interoperability supports data collection for research. This research can lead to improved clinical guidelines and practices.

How Interoperability is Achieved

Behavioral Health Interoperability DiagramInteroperability has created a national push for health information exchange. Technology is necessary to accommodate data sharing. The Centers for Medicare and Medicaid released a Final Rule outlining Stage 3 of the Electronic Health Record Incentive Program. The rule was designed to promote interoperability with a focus on the use of electronic health record (EHR) technology and the exchange of health information between systems.

$36 billion was budgeted for health information technology (HIT) infrastructure as a part of the federally‐funded Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. Of that, $34 billion was allocated for the Medicare and Medicaid EHR Incentive Programs. The goal of these programs is to provide more effective healthcare by encouraging the adoption, implementation, or upgrade of certified EHR technology. Certification is mandated by the Office of the National Coordinator for Health Information Technology (ONC).

With these systems in place, practitioners have the ability to review a patient’s complete health record. As a result, this knowledge enables providers to make more informed decisions related to patient care and to coordinate care for their clients. The electronic tools are designed to reduce the burden of these types of communication.  

On the behavioral health front, agencies have been slow to adopt for a variety of reasons. However, some states, like North Carolina, require all organizations funded by Medicaid to participate in order to continue receiving payments for their services. So, there is a crunch on behavioral health agencies to rush to implement a Behavioral Health EHR that meets their unique needs in a timely manner.

Learn more about Interoperability




CMS and ONC Propose New Rules for Interoperability

Rules for Interoperability and Patient Access to Electronic Health Information

The U.S. Department of Health and Human Services (HHS) recently proposed new rules to support seamless and secure access, exchange, and use of electronic health information (EHI). The rules were issued by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC). The intention of the rules is to increase choice and competition, which will be realized by:

  • Improving secure patient access to their health information
  • Giving patients more control over their health information
  • Requiring that patient access to the EHI be free to patients

ONC’s Proposed Rule

Electronic Health Information and Patient Access

ONC’s rule promotes secure and (more) immediate access to health information. This applies to both patients and their providers. The rule calls for the adoption of standardized application programming interfaces (APIs). APIs will enable patients to access their data using their smartphones and other mobile devices.

Additionally, the rule implements the information blocking provisions outlined in the 21st Century Cures Act. This will support access and exchange of electronic health information . The rule included seven proposed exceptions to the definition of information blocking, as well.

ONC also proposes patients be able to access their EHI at no cost. This would help patients see the prices they are paying for their healthcare.

Finally, ONC’s proposed rule would modify the 2015 Edition health IT certification criteria and program to advance interoperability, enhance health IT certification, and reduce burden and costs.

CMS’s Proposed Rule

CMS’ proposed changes to the healthcare delivery system support the MyHealthEData initiative. The goal of the changes is to increase the flow of health information, reduce burden on patients and providers, and foster innovation. In 2018, CMS finalized regulations that use potential payment reductions for hospitals and clinicians to encourage providers to improve patient access to their electronic health information. CMS is now proposing requirements that Medicaid, the Children’s Health Insurance Program, Medicare Advantage plans and Qualified Health Plans in the Federally-facilitated Exchanges provide patients with immediate electronic access to medical claims and other EHI by 2020.

CMS would also require these health care providers and plans to implement open data sharing technologies to support transitions of care as patients move between these plan types. By ensuring patients have easy access to their information, and that information follows them on their healthcare journey, redundant procedures and testing will be eliminated. Thus, clinicians will have the time to focus on improving care coordination and, ultimately, health outcomes.

CMS Administrator Seema Verma said, “By requiring health insurers to share their information in an accessible format by 2020, 125 million patients will have access to their health claims information electronically. This unprecedented step toward a healthcare future where patients are able to obtain and share their health data, securely and privately, with just a few clicks, is just the beginning of a digital data revolution that truly empowers American patients.”

Combined, these proposed rules address technical and industry factors that create barriers to interoperability and limit a patient’s ability to access their health information. Aligning these requirements for payers, health care providers, and health IT developers will help drive an interoperable health IT infrastructure across systems. This ensures providers and patients have access to health data when and where it is needed.

Additional Resources:

Fact sheet on the CMS proposed rule (CMS-9115-P)

Fact sheets on the ONC proposed rule

To read all 724 pages of the HHS’s new rules





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The Clock is Ticking for Behavioral Health: It is time to get you connected to your Health Information Exchange (NC HIE)

NC HIE Connection Patagonia Health

If you haven’t heard yet, North Carolina has taken a big step towards connecting and sharing health information for providers who bill to Medicaid. The North Carolina Health Information Exchange (NC HIE) is still enroute to its February 1, 2018 deadline that will require all Medicaid providers to connect to the NC HIE if they want to receive payments for the Medicaid services they provide.

This means that all providers who intend to receive payments from Medicaid will need an Electronic Health Record (EHR) platform that can connect or is already connected with the NC HIE. Starting June 1, 2018, the connect requirement will extend to all entities looking to receive any state funds for delivering health services, which would include managed care organizations and management entities or related groups. This is an important NC Medicaid update and while this particular date is for NC providers only, it is a theme in the future of healthcare. The push for Interconnectivity will be more widespread throughout the nation as information sharing becomes inextricably linked to better patient care and safety.

Many other states are also beginning to require connection to State and Regional HIEs to improve data sharing amongst providers in different health departments, community health centers, and even private practices. Medicaid and Medicare are already providing the catalysts for pushing these connections as they serve patients who typically see many providers.

Not every EHR has the capability of connecting with HIE, so it is important to verify this capability before pulling the trigger on a new software or assuming your current software is willing and able to connect. Any EHR you choose as a Medicaid provider also needs to be federally certified, ensuring your compliance with other Medicaid and Medicare requirements and mandates. Not every EHR is created equal, so be sure to do your due diligence and research before committing to a system that cannot get you where you need to be. To check if an EHR is federally certified, you can go to the Certified Health IT Product List.


For more information on the NC Health Information Exchange, visit their website

For more information on Medicaid requirements in your state, visit your state CMS website