Health information exchange (HIE) is a significant part of healthcare data systems. Wager, Lee, and Glaser (2017) argue that HIE “serves as a building block for improved patient care, quality, and safety” (p. 117). HIE facilitates the accessibility of relevant patient information, thus helping companies to avoid duplication of services, automate administrative tasks, and achieve sufficient oversight of data exchange processes (Wager et al., 2017).
Most states in the U.S. have implemented HIE systems to enhance health care quality and coordination. The present paper will discuss the HIE system used in California in terms of its effect on the coordination of care, public health initiatives, and evidence-based research. The essay will also seek to compare the HIE system used in California to those in Georgia, Maryland, and Nevada.
California is similar to Georgia, Maryland, and Nevada regarding population demographics, including the share of white and non-white populations, median household income, and median age. One significant challenge in comparing California healthcare to other states is the high percentage of uninsured persons. According to Truth in Accounting (2018), California has the highest percentage of uninsured persons after New York, which has a significant effect on health care data exchange in the state.
In California, the HIE landscape is comprised of community-based initiatives and enterprises. Information sharing occurs through California Trusted Exchange Network (CTEN), which enables providers to submit and view data (California Association of Health Information Exchanges [CAHIE], 2018). Similarly, in Georgia, Nevada, and Maryland, information sharing is facilitated by a single statewide network.
Using a single network allows all subscribed state providers to upload and receive information about patients. All of the state systems identified as part of the comparison include similar types of data, such as admissions, discharges, transfers, immunizations, prescriptions, text reports, and lab results. The coverage of facilities is also comparable, with 95-100% of the states’ acute hospitals enrolled in the respective state network. Therefore, the health information exchange system used in California is similar to the three chosen states in terms of its centralization, content, and coverage.
Coordination of Care
California HIE system enables improved coordination of care by providing an opportunity to share data across numerous providers and institutions through a single network. According to the Healthcare Information and Management Systems Society (HIMSS, 2014a), sharing information about patients, their health status, and treatments supports provider decision-making. For example, it can help to reduce the probability of duplicate services, as the providers will know if a patient received a particular service at another institution. As California HIE system includes both enterprises and community health initiatives, it can be used to support best practices in patient care.
In addition, the scope of California HIE allows maintaining track of care providers and patients. HIMSS (2014a) notes that, by including provider directory, HIEs can assist care providers with referrals and transfers. This also facilitates the coordination of care, as providers receive information about the patients referred or transferred to them, including their past diagnoses, lab results, and treatments.
Including community-based services in the registry also enables providers working with California HIE system to equip patients with information about community support resources. For instance, if a patient is at risk of diabetes and there is a community-based initiative for diabetes prevention in their local area, a physician will be able to provide relevant information and recommend using this service.
One weakness of California HIE is the lack of a culture of interoperability. As noted by HIMSS (2014b), a culture of interoperability ensures that all care providers use HIE systems and share data as part of their on-going operations. However, in California, the percentage of certain types of providers enrolled in HIEs remains low. For example, less than 20% of substance use care providers and about 50% of EMS and mental health providers exchange information through the state system. This could affect the coordination of care in these areas, as new care providers will not be able to access essential patient data.
Public Health Initiatives
California HIE offers an example of successful integration of both enterprises and health initiatives, which helps to support public health initiatives throughout the state. First of all, California HIE aids providers in connecting with local public health initiatives and refer patients to them for further support. This can help to expand the coverage of public health initiatives and raise their overall effectiveness, as it promotes patients’ awareness of services. Secondly, the information shared through HIE can assist authorities and providers in decision-making regarding public health initiatives. For instance, an increased prevalence of a certain condition in the state’s population could serve as a foundation for developing new public health programs and efforts.
Lastly, by using a single network for information exchange, California HIE allows to track progress and monitor the success of public health initiatives. If a patient had participated in a public health program, their future medical information could be used to judge the efficiency of efforts. The results of this analysis, in turn, could help to tailor effective health promotion initiatives, thus raising the overall health status of people living in California.
California HIE also facilitates evidence-based research by maintaining a clinical data repository. Most repositories contain comprehensive medical information, such as lab results, medication history, controlled substances history, and care plans (HIMSS, 2014a). Using this information for research purposes helps to enhance evidence-based research quality. Firstly, maintaining a clinical repository enables California HIE system to provide population health information to researchers.
This is particularly valuable in longitudinal research and studies with large samples. Using information from the state HIE system, researchers in California can identify areas of interest and perform retrospective studies. Moreover, a clinical data repository enables researchers to obtain larger volumes of information, which enhances the quality of their studies. It also allows tracking the effectiveness of specific interventions over time, providing evidence of their applicability to practice.
Nevertheless, the use of medical information from HIEs by researchers poses some concerns. The U.S. Department of Health & Human Services (2017) states that electronic technologies, including HIEs, could affect the privacy of health information. Thus, by providing researchers with access to medical information of patients, California HIE system compromises patient privacy and confidentiality. In order to resolve this issue, it is critical to establish sufficient control over the use of HIE for research purposes.
All in all, HIE in California is comparable to the ones applied in states with similar demographics. It provides the opportunity for health professionals to share data about treatments, immunizations, ADTs, and other important medical events, which promotes care coordination, improves public health initiatives and supports evidence-based research. However, the system used in California presents some concerns with regards to the culture of interoperability and patient privacy. Addressing these issues would help to strengthen health information exchange in the state, thus enhancing its outcomes.
California Association of Health Information Exchanges (CAHIE). (2018). HIE landscape. Web.
Healthcare Information and Management Systems Society (HIMSS). (2014a). Care management and HIE. Web.
Healthcare Information and Management Systems Society (HIMSS). (2014b). The business case for interoperability and health information exchange. Web.
Truth in Accounting. (2018). State data and comparisons. Web.
U.S. Department of Health & Human Services. (2017). HIPAA for professionals. Web.
Wager, K. A., Lee, F. W., & Glaser, J. P. (2017). Health care information systems: A practical approach for health care management (4th ed.). Hoboken, NJ: John Wiley & Sons.