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Section 5.8 Maintain
HIE Goals and Governance
Understand how various health information exchanges (HIEs) have formed, why they have formed,
their governance models, and their technical architectures.
Time needed: 4 hours
Suggested prior tools: 1.8 HIE Technical Readines Inventory
How to Use
1. Review the information on HIE governance models and technical architectures.
2. Use the tips included as you consider the potential for participating in such structures.
HIE Governance Models
Health information exchange is the secure, electronic movement of health-related information among
organizations in ways that enable the information can be used by both the sender and receiver of the
information (see 1.8 HIE Technology Readiness Inventory). Organizations, often referred to as health
information exchange organizations (HIOs), have formed to oversee the exchange of health-related
information. HIO participants may include different types of health care providers, public health
departments, employers, payers, and consumers, directly or through their families and caregivers.
Different approaches to how HIOs have formed include:
□ Integrated delivery networks (IDNs) or health systems. Although these groups
significantly pre-date the newer models of HIOs, IDNs are organizations that have common
ownership and are more readily able to both mandate the structure and functions of the HIE
as well as overcome some of the financing hurdles other HIOs have had. IDNs, however,
have some of the same challenges as new HIOs, especially where the IDN includes facilities
with many different types of information systems and care delivery systems, and span several
states. A nursing home may be physically integrated with a hospital, yet be unable to
exchange information electronically due to lack of vendor compliance with standards or other
technical limitations.
Tip: Learn more about issues associated with connectivity within IDNs and broader HIE
organizations (see 1.10 Interoperability for EHR and HIE).
□ Public-mediated. This model has most commonly been supported through state government,
and in some cases state government certifies the capabilities of an HIO to exchange data. In a
few cases, local or regional governments have also supported or come together to support an
HIO. Public-mediated HIOs will often support the “lowest common denominator” of
exchange, but do so across many organizations. For example, some may only support the
exchange of lab results, emergency department information, and/or immunization data. Yet
these exchanges may actually meet most of the participants’ information exchange needs.
Some states may provide a public-mediated HIO and also support privately-mediated HIOs
through an oversight function to ensure fair practices and compliance with state privacy
protections.
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Tip: If an HIO has formed in your state or other geographic area, consider participating in its
public accountability forums so that the needs of nursing homes are adequately addressed.
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Private-mediated. Private-mediated HIOs, such as through a private business, include
several subtypes:
o Community hospital-supported HIOs, often in rural communities, are those in
which the main hospital in the area supports an HIO across a geographic region to
improve transitions of care. The participants are not owned by the hospital but the
hospital has found it cost-effective to support improvement in electronic exchange
among physician practices, long term care facilities, labs, pharmacies, and other
organizations.
o Health plan-supported HIE may not always be recognized as a form of HIO
because the plans may not describe their HIE functions in that way. These health
plans, however, are mediating the compilation of clinical summary data in a registry
and making that data available not only to providers who contract with the health plan
but to other providers in the community to support care coordination and
accountability for care. Most commonly, the health plan produces periodic reports on
quality measures. Some health plans have begun to provide individual patient
snapshots or clinical summaries for use at the point of care. For instance, pharmacy
benefits managers are consolidating medication information to be able to provide a
complete picture of an individual’s medications to providers as they make new
medication decisions. This kind of structure enabled victims of Hurricane Katrina to
get the medications they needed. MyMedicare.gov is also providing this capability
for medications, allergies, implantable devices, immunizations, medical conditions,
and family history.
o Vendor-mediated HIOs are those in which a particular vendor who is prominent in a
geographic area facilitates the exchange of data across its client providers. The
commonality of the product, even if implemented slightly differently in different
settings, makes it easier to achieve a robust form of exchange—but only among these
clients.
Tip: A corporation-owned skilled nursing facility in a state with an active HIO program may
need to determine whether its HIO can be qualified to participate in the state-mediated HIO.
□ Other models
Although not considered an HIO, individuals who maintain personal health records (PHR)
are often in the position to use their PHR as a means to exchange health information. The
individual or family functions as a conduit through which clinicians in different settings
communicate information. Such PHRs may be tethered to a hospital or physician office, may
be independent commercial web-based products, or may exist within the organizational
structure of an HIO.
Tip: Begin to collect information on how many of your residents’ families are maintaining
PHRs, including those who have signed up for MyMedicare.gov. Consider supporting even a
paper-based PHR to structure their information collection to satisfy their personal needs and
facilitate communication with your skilled nursing facility. Evaluate options to sponsor or
promote a free Web-based PHR service from your home page to encourage further
standardization. Develop a policy and procedure on PHR use (see 4.6 Policy Procedure
Checklist) to guide your clinicians in accepting information from a PHR source.
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Other important HIE elements to understand:
□ HIE goals
Why has the HIE organization come together? Is it to exchange a limited amount of critical
data for individuals who transfer their care between organizations (e.g., in emergency
situations)? Is it to reduce information processing costs, etc.?
Tip: Goals of the HIO should be aligned with the goals of any organization seeking to
participate. However, many HIOs are still in the formative stages. If you are interested in
seeing an HIO in your community or state succeed, consider participating in planning
activities that will direct its goals.
□ Governance
Who are the lead players? Is the governance model leaning toward acute care, ambulatory
care, care across the continuum, or payers?
Tip: Once again, to consider participating in an HIO, the governance should be aligned with
your interests. Evaluate both formal members and informal leaders in the HIO to determine
your potential success in the organization.
Copyright © 2014
Section 5 Maintain—HIE Goals and Governance - 3
Updated 03-19-2014