The State HIE Cooperative Agreement Program grantees are required to monitor and
track statewide implementation, adoption, and transactions of exchange mechanisms
that they implement directly or enable through funding, technical assistance,
marketplaces, etc. to support the meaningful use of health information technology.
Research the current state of HIE across the United States through the link below&and
provide a response summarizing your findings related to your state of residence.
Provide a summary of your findings and any insights you have gained in the review of
the information:
https://www.healthit.gov/topic/onc-hitech-programs/state-health-information-exchange
For your replies, respond to 2 classmates, identifying at least 1 strength and 1
weakness in each classmate's reasoning.
Your thread is due by&11:59&p.m.&(ET)&on Thursday.&Your replies are due by&11:59&p.m.&(ET)&on
Sunday of&Module/Week 2.
Health Information Exchange
Health Information Exchange or HIE is integral to health informatics and is the pathway
through which EHRs and other health system data are made accessible to the required users of
said records (Braunstein, 2014). Per Braunstein (2014), “HIE is essential for coordinating
healthcare, but it has other important and growing applications” (p. 55) such as in medical
research, public health surveillance, and resolution of system interoperability issues.
Historically, however, it has not been readily accepted by users of health records, especially
without incentive (Braunstein, 2014). Per Shanholtzer and Ozanich (2016), HIE can be further
classified into a verb and a noun, the former being the process flow of exchanging health
information and the latter being public or private organizations which engage in health
information exchange activities such as managing HIE technologies and ensuring compliance
with privacy and security laws. Examples include accountable care organizations, statewide
HIEs, and payers of health services such as Medicaid or Medicare (Shanholtzer & Ozanich,
2016).
In addition to the development of HIE as a system of data exchange and HIE
organizations, there exist certain programs to promote the use and development of HIEs. An
example is the State Health Information (State HIE) Exchange Cooperative Agreement Program,
which was organized by the ONC and launched in 2010 (ONC, 2019a). According to the official
website for the ONC, the objectives of this program are to award funding throughout the US to
be used for the adoption and development of HIE usage, systems, and processes (ONC.gov,
2019b). This program initially granted $548 million across the board (ONC, 2011) with award
amounts varying depending on the state or territory. For example, Hawaii received $5.6
million, Louisiana received $10.58 million, and New York received over $22 million (ONC,
2019a).
Hawai’i Health Information Exchange
The Hawai’i Health Information Exchange (“Hawai’i HIE”) describes themselves as “the
State’s designated entity for health data exchange”, designated in 2009 (Hawai’i Health
Information Exchange, n.d.a). Hawai’i HIE engages in the activities described in the section
above with organizational goals of lowering local healthcare costs, improving data access and
integrity, creating positive impact on local public health, and providing governance (Hawai’i
Health Information Exchange, n.d.a). Participants under Hawai’i HIE are plentiful and include
major healthcare organizations, hospitals, laboratories and clinics, such as Hawai’i Department
of Health, US Department of Veterans Affairs, Queens Health Systems, Hawai’i Pacific Health,
HMSA, Kaiser Permanente, Clinical Laboratories of Hawai’i LLP, Hawaii Homeless Healthcare
Hui, and more (Hawai’i Health Information Exchange, n.d.b). They utilize a data exchange
system called Heath eNet which they explain is strong in interoperability as well as rating well in
security and efficiency (Hawai’i Health Information Exchange, n.d.c).
Hawai’i HIE is proud that across the 8 Hawaiian Islands, 24 major entities are connected
and committed to contributing to Community Health Records (CHRs), making use of shared
patient data, and helping to enhance Hawai’i HIE objectives of improving clinical decision-
making and creating a better quality of life for the Hawaiian population (Hawai’i Health
Information Exchange, 2019). Per Van Brunt (2017), the use of CHRs is critical to the
improvement of public health. Van Brunt (2017) describes the CHR as a cousin of EHRs and
PHRs, with the difference being that a CHR is focused on relating the contained health records
to the geographic community. “CHRs can be used as a public health surveillance tool, a
standardized baseline set of data from which public health and other organizations can begin to
systematically reengineer their communities to improve health and quality of life,” (Van Brunt,
2017, p. 408). Thus, it is easy to see why Hawai’i HIE is committed to adopting and promoting
the use of CHRs, as their mission includes improving local public health.
Biblical Integration
Government establishment of HIE-related organizations reminds me of Luke 10:34,
which states “He went to him and bound up his wounds, pouring on oil and wine. Then he set
him on his own animal and brought him to an inn and took care of him,” (English Standard
Version Bible, n.d.). The correlation I see in the two is an effort to improve things for those who
ail, or those who may ail in the future. Government intervention may not be perfect and could
still benefit from some improvement, but the dedication of the ONC to form state HIEs and
create incentives for participation shows there is commitment to the cause; a desire to heal the
wounds not just through medical care, but in back-end processes that impact medical care.
State HIEs are a powerful way to help transform the industry from cumbersome paper-based
practices into efficient, information-powered entities.
References
Braunstein, M. (2014). Contemporary health informatics. American Health Information
Management Association.
English Standard Version Bible. (n.d.) ESV.org. https://www.esv.org
Hawai’i Health Information Exchange. (n.d.a). Our Vision/Our Mission. HawaiiHIE.org.
https://www.hawaiihie.org/mission
Hawai’i Health Information Exchange. (n.d.b). Management team. HawaiiHIE.org.
https://www.hawaiihie.org/management-team
Hawai’i Health Information Exchange. (n.d.c). Services. HawaiiHIE.org.
https://www.hawaiihie.org/services
Hawai’i Health Information Exchange. (2019). Patient data is flowing!
https://hawaiihie.org/data-flow
Shanholtzer, M. B. & Ozanich, G. (2016). Health information management and technology.
McGraw-Hill Education.
The Office of the National Coordinator for Health Information Technology (ONC). (2011). Get
the facts about state health information exchange program. HealthIT.gov.
https://www.healthit.gov/sites/default/files/get-the-facts-about-state-hie-program-
2.pdf
The Office of the National Coordinator for Health Information Technology (ONC). (2019a). State
health information exchange. HealthIT.gov. https://www.healthit.gov/topic/onc-hitech-
programs/state-health-information-exchange
The Office of the National Coordinator for Health Information Technology (ONC). (2019b). What
is the state health information exchange cooperative agreement program? HealthIT.gov.
https://www.healthit.gov/faq/what-state-health-information-exchange-cooperative-
agreement-program
Van Brunt, D. (2017). Community health records: Establishing a systematic approach to
improving social and physical determinants of health. American Journal of Public Health,
107(3), 407-412. https://doi.org/10.2105/AJPH.2016.303602
Response #1:
I thought you did a good job thoroughly explaining Virginia’s State HIE, Connect Virginia.
It was interesting to read your contribution after preparing my case as I live in Hawaii so our
respective HIEs operate a little differently. One thing that stood out to me about Hawaii’s HIE
was their commitment to developing CHRs (community health records) which Van Brunt (2017)
describes as a set of population-level health records allowing geographic regions to aggregate
health information to map trends and compare metrics with other geographic regions.
Strengths
I liked the scripture that you chose to tie into your post and felt it was very fitting. You
selected Hebrews 13:16 which states “Do not neglect to do good and to share what you have,
for such sacrifices are pleasing to God” (English Standard Version Bible, n.d.). To me, this ties in
very well to the concept of advancing healthcare operations from an HIE standpoint. As
mentioned in Shanholtzer and Ozanich (2016), there are huge benefits to the adoption of HIEs,
including enhanced continuity of care, standardization of records, improved public health
surveillance, and better patient care in areas such as testing (elimination of duplicates) and
medicine reconciliation. However as noted in Braunstein (2014), early efforts to promote HIE
were fairly fruitless in the absence of financial incentives.
The scripture you selected encourages people to make sacrifices in order to do good –
very true in the case of adopting an HIE. Of course, HIEs once fully implemented will be very
beneficial to an organization, however the transitionary state will be hard. As such, it is a
sacrifice to switch, but it means the organization is doing right by the patient. Another
scripture I like that I found fitting with this week’s material is Luke 9:11: “When the crowds
learned it, they followed him and he welcomed them and spoke to them of the kingdom of God
and cured those who had need of healing” (English Standard Version bible, n.d.). This scripture
makes me think of the statewide HIE initiatives and ONC’s efforts to bring as many providers on
board as possible. The ONC connects with healthcare organizations through the designated
state HIE in place for the region and highlights the need for the adoption of this technology,
which will elevate participating healthcare organizations into entities even more capable of
healing.
Weaknesses
My least favorite part of these assignments is having to pick out a weakness, but I
suppose we can always find ways to improve. As mentioned above, I felt you did a thorough
job of describing Virginia’s statewide HIE organization. A possible area for improvement would
be tying in more sources to help support and validate your points. For example, in your
discussion you explained that the sharing and flow of public health-related data was an
objective of Connect Virginia and explained a few ways in which they achieve this via use of HIE
technology. A way to strengthen the discussion would be to explain not just how they achieve
these goals but a bit more background on how they are important. For example, Shapiro et al.
(2011) presented multiple use cases for how public health can be positively impacted via HIE,
such as how population-level monitoring could become higher quality and thus allow
healthcare organizations to develop better preventative care plans. CHRs, as mentioned in my
intro, are also great tools which enable public health surveillance and enable users to map ways
to use the data to improve public health (Van Brunt, 2017). Tying in a few references such as
these could help drive the point home a bit more about what HIEs are doing for the US
population at large.
Overall, great post!
References
Braunstein, M. (2014). Contemporary health informatics. American Health Information
Management Association.
English Standard Version Bible. (n.d.) ESV.org. https://www.esv.org
Shanholtzer, M. B. & Ozanich, G. (2016). Health information management and technology.
McGraw-Hill Education.
Shapiro, J., Mostashari, F., Hripcsak, G., Soulakis, N., & Kuperman, G. (2011). Using health
information exchange to improve public health. American Journal of Public Health,
101(4), 616-623.
https://search-proquest-com.ezproxy.liberty.edu/healthmanagement/docview/
860165487/fulltext/315CBA02F1594954PQ/7?accountid=12085
Van Brunt, D. (2017). Community health records: Establishing a systematic approach to
improving social and physical determinants of health. American Journal of Public Health,
107(3), 407-412. https://doi.org/10.2105/AJPH.2016.303602
Response #2:
I appreciate your contribution this week and your discussion of your state’s HIE
program. I live in a different state, so it is helpful to read others’ posts to get a better
understanding of the ins and outs of the other regions.
Strengths
You had several strengths in your discussion post. You pointed out that the industry is
trying to enhance preventative healthcare practices over treatment-based approaches and that
this is why HIEs are so beneficial to the organization and the people they serve. I agree with
your sentiments that despite this trend, it is still difficult to get organizations on board. As
stated in Shanholtzer and Ozanich (2016), “The healthcare industry has always been
fragmented by both region and specialization. There is no national healthcare system…[and]
[v]endors of HIT products independently developed their own products, with limited focus on
connecting with others” (p. 215). Due to a lack of standardization each organization was
responsible to find their own way to collect their own data therefore it is no surprise it would
be a challenge to get them to switch to new methods. Per Braunstein (2014), the point of HIEs
is to try to resolve the issue of interoperability by developing standardization for the industry
and then encouraging the implementation of the developed technology.
Another strength of your post was the scripture you chose to relate to this topic. You
chose Galatians 6:9, which states that we should not grow weary of doing the right thing and
that as long as we persist, we will reap benefits. I think this ties in perfectly to the topic of HIEs
and the challenges in convincing organizations to adopt new technological standards. From the
standpoint of an organization who may feel discouraged or overwhelmed by the process of
implementing this technology, this scripture reminds that there will be success at the end of
these efforts. It is a motivating piece for sure. Another scripture which I like that I feel is
applicable is Proverbs 14:23: “In all toil there is profit, but mere talk tends only to poverty”
(English Standard Version Bible, n.d.). For all the effort healthcare organizations put into this
venture, there will be benefits: reduced costs, lower margins of error, healthier patients,
improved public health, happier staff. If they neglect to properly utilize the funding allocated to
them by the State cooperative agreement, they are only doing themselves a disservice and are
also failing their client base as well, thus robbing themselves and others of the richness this
new technology can bring to them.
Weaknesses
Your article was well written and backed up by literature. One thing you could possibly
have expanded on, however, was the last sentence in your 2nd paragraph where you briefly
mentioned a drawback of HIEs is the privacy and security concerns that come along with it. To
strengthen your discussion here it may have helped to give specific examples of how this
applies. For example, LeRouge et al. (2016) explain that intrastate HIE connections mesh better
than interstate HIE efforts due in large part to differing privacy laws across the country as well
as differences in consent requirements. Also mentioned is a fear from organizations that
interstate health record sharing may result in improper disclosure by an organization in another
region due to differing laws about how the information can be used from state to state
(LeRouge et al., 2016). Issues like these are very real concerns that likely contribute quite a bit
to entities hesitating to commit to adopting HIE within their organization.
Overall I felt that your contribution this week was strong and helpful to both myself and I’m
sure our other classmates as well.
References
Braunstein, M. (2014). Contemporary health informatics. American Health Information
Management Association.
English Standard Version Bible. (n.d.) ESV.org. https://www.esv.org
LeRouge, C. M., Hirsch, J. L., Feldman, S. S., & Bass, A. L. (2016). Interstate health-information
exchange: Understanding value propositions and challenges. Innovation and
Entrepreneurship in Health, 3, 69-77. https://doi.org/10.2147/IEH.S70055
Shanholtzer, M. B. & Ozanich, G. (2016). Health information management and technology.
McGraw-Hill Education.
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