Health Information Exchange: The Long Road

In a recent entry in Health Affairs, the Office of the National Coordinator released some information on the strategy for advancing the exchange of health information over the next years. We start with the obvious: most health information today is not shared electronically, with fax and mail still being the major exchange method. Because of this, health information remains largely in the hands of providers, with little to no info following the patient along their path to care.

However, as Meaningful Use regulation becomes more consistent and the founding pillars of HIE standards are developed, health information exchange is poised to grow. For this infrastructure to reach its potential, certain changes and policies need to be put in place to overcome todays challenges in the sharing of clinical information. The ONC put patients at the center of health information exchange, keeping clinical data WITH THE PATIENT rather than with the provider.

Currently, Meaningful Use requires very little health information exchange to happen (mainly since this industry is still in it’s infancy and regulatory procedures are still very fluid and under development. The requirements (mentioned in Exhibit 1 of the article – below) serve mainly general purposes while HIE as an infrastructure is defined.


As noted by the ONC, “no investment in standards or infrastructure […] will rapidly mobilize information sharing if the underlying demand for shared information is low.” The current fee-for-payment structure, which rewards quantity over quality, does very little to incentivize the sharing of clinical information.

The article then sets to characterize three main types of health information exchange, all with varying levels of access and complexity.

The first, named directed exchange, focuses on providers sending and receiving health information when they exchange patient information (like labs, referrals, discharge summaries etc). In layman terms, directed exchange happens when there is intent to access SPECIFIC patient information from provider to provider.

Query-based exchange refers to unplanned care. For example, an ER physician that has not been previously involved in a patient’s care can look up patient information that could positively influence the course of treatment. This type of exchange would assume large databases containing patient information from multiple entities (insurance carriers, hospitals, PCPs, specialists etc).

The last of the exchanges, the consumer-mediated exchange, focuses on patient access to care. It is assumed that patients with access to their own health information will “improve the effectiveness and coordination of their health by sharing information with other providers […] and making more-informed decisions.” This is where patients become the major player that they need to be. Consumer-mediated exchange empowers patients to become decision makers.

The Office of the National Coordinator has also set some priorities for 2012, which I summarized in the table below:


All information in this post was taken from the publication cited below:

Claudia Williams, Farzad Mostashari, Kory Mertz, Emily Hogin and Parmeeth Atwal. From The Office Of The National Coordinator: The Strategy For Advancing The Exchange Of Health Information Health Affairs, 31, no.3 (2012):527-536

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