Health Information Exchange: Navigating and Managing a Network of Health Information Systems

Cover
Health Information Exchange
Copyright
List of contributors
Foreword*
References
Contents
Preface
Acknowledgments
1 Introduction to health information exchange
1.1 Introduction
1.2 Health information exchange
1.2.1 HIE as a verb
1.2.2 HIE as a noun
1.2.2.1 How HIE is used in this book
1.2.3 Typology of Health Information Organizations
1.2.3.1 Enterprise HIE
1.2.3.2 Community-based HIE
1.2.3.3 Government-facilitated HIE
1.2.3.4 Vendor-facilitated HIE
1.2.3.5 Health record banking
1.2.4 Fundamental components of HIE
1.2.4.1 Health system actors and relationships
1.2.4.2 ICT Systems
1.2.4.3 Transactions or messages
1.2.4.4 Content or payload
1.3 Evolution of health information exchange in the United States
1.4 HIE outside the United States
1.5 Purpose and structure of this book
1.6 Summary
Questions for discussion
References
2 Health information exchange as a profession
2.1 Introduction
2.1.1 Implementation and adoption of electronic health records and health information exchange
2.1.2 Incentives promoting use of electronic health records and increasing the health information technology workforce
2.1.3 Promoting use of electronic health records and health information exchange globally
2.2 Human resource needs—digital health information professionals
2.2.1 The nature of eHealth/digital health information professionals: their competencies, roles, and work
2.2.2 Who are the eHealth/digital health information professionals?
2.2.2.1 Health informaticians (HI professionals)
2.2.2.2 Residency and fellowship training—clinical informatics subspecialty
2.2.2.3 Health informatics for nonclinicians
2.2.2.4 Health information management professionals
2.2.2.5 Health information technologists or health information and communications technologists
2.2.2.6 Health information security specialists
2.2.2.7 Health data analysts
2.2.2.8 Health information exchange professionals
2.2.3 Other key personnel—clinical healthcare professionals
2.2.3.1 Medical and clinical trainees
2.3 Digital health information professionals—supply and demand
2.4 Skills and training of digital health professionals
2.4.1 Current credentials offered
2.5 Defining and executing a future strategy for health informaticians and health information exchange professionals
2.5.1 Health information workforce development
2.6 Emerging trends
2.6.1 Education
2.6.2 Continued ONC-HIT Workforce Development—public health informatics
2.7 Summary
Questions for discussion
References
3 Policies and incentives for adoption: toward broader use
3.1 Introduction
3.2 Landscape of the health information exchange marketplace
3.2.1 Adoption of health information exchange functionalities
3.2.2 Evolution of health information exchange organizations
3.2.3 International growth in the adoption of health information exchange
3.2.4 Health information exchange usage by providers
3.2.5 Barriers to adoption
3.2.6 Drivers of adoption
3.2.7 Health information exchange policy at the state and national level
3.3 Emerging trends
3.3.1 New policies to advance health information exchange adoption and use
3.3.2 Blockchain may advance security of health information exchange
3.3.3 Driving health information exchange adoption through Big Data initiatives
3.3.4 Impact of General Data Protection Regulation on health information exchange adoption
3.3.5 Information blocking policies
3.4 Summary
Questions for discussion
References
4 Engaging and sustaining stakeholders: toward governance
4.1 Introduction
4.2 Governing bodies
4.2.1 Governing body types
4.2.1.1 Board of directors
4.2.1.2 Network governing committee
4.2.1.3 Data governance committees
4.2.2 Participants
4.2.3 Representativeness
4.3 Policies and procedures
4.4 Data sharing “Trust” agreements
4.5 Governance key success factors
4.5.1 Trust
4.5.2 Scale
4.5.3 Flexibility
4.6 Governance challenges
4.7 Enterprise exchange challenges
4.8 Regional exchange challenges
4.9 State health information organization challenges
4.10 Nationwide exchange challenges
4.11 Community-based health information exchange network governance example: Indiana Network for Patient Care
4.12 Government-facilitated health information exchange network example: Virginia Health Information
4.13 National health information exchange network governance example: eHealth Exchange
4.14 Emerging trends
4.15 Summary
Questions for discussion
References
5 Managing the business of health information exchange: moving towards sustainability
5.1 Introduction
5.2 Sustainability for the various forms of health information exchange is different
5.2.1 Sustaining enterprise health information exchange networks
5.2.2 Sustaining government-facilitated health information exchange networks
5.2.3 Sustaining vendor-facilitated health information exchange networks
5.2.4 Sustaining Health Record Banks
5.2.5 Sustaining community-based health information exchange networks
5.3 Business 101 for Health Information Organizations
5.3.1 Key business definitions
5.4 Hypothetical case study to illustrate sustainability
5.5 Increasing health information exchange revenue
5.5.1 Increasing revenue by adding customers
5.5.2 Increasing revenue by adding services
5.6 Increasing the gross margin per service
5.6.1 Setting prices
5.6.2 Reducing the cost of service delivery
5.7 Reducing overhead costs of an health information exchange business
5.8 Planning for sustainability
5.8.1 Start with sustainability in mind
5.8.2 Mission
5.8.3 Organizational structure
5.8.4 Business model
5.8.5 Dissemination of the value of the health information exchange network
5.9 Challenges to sustainability
5.10 Health data utilities, an emerging model for health information exchange networks
5.11 Summary
Questions for discussion
References
6 Managing privacy, confidentiality, and risk: towards trust
6.1 Introduction
6.1.1 Privacy
6.1.2 Confidentiality
6.1.3 Security
6.1.4 Accountability
6.1.5 Privacy risk
6.2 Federal and state laws pertaining to health information exchange
6.2.1 Sensitive data
6.2.2 HIPAA and the HITECH Act
6.2.3 What is regulated?
6.2.4 The Privacy Rule and the Security Rule
6.2.5 The Privacy Rule
6.2.6 The Security Rule
6.2.7 Managing privacy risks
6.2.8 Breach notification rule
6.2.9 HIPAA enforcement
6.3 Information blocking regulations
6.4 Contracts
6.4.1 Point-to-point agreements
6.4.2 Two-party agreements
6.4.3 Multiparty agreements
6.5 Summary
Questions for discussion
References
7 Managing threats to health data and information: toward security
7.1 Introduction
7.1.1 Healthcare information security regulations
7.1.1.1 HIPAA Security Rule
7.2 Health Information Technology for Economic and Clinical Health Act
7.3 Breach Notification Rule
7.3.1 What’s really considered Unsecured Protected Health Information
7.3.2 Ransomware, HIPAA, and HITECH Act Breach Notification Rule implications
7.3.3 Vulnerabilities and breaches
7.4 21st Century Cures Act Final Rule
7.5 NIST Cybersecurity Framework 1.1
7.5.1 Global regulations and frameworks
7.5.2 ISO/IEC 27001
7.5.3 European Union General Data Protection Regulation
7.5.4 Operationally Critical Threat, Asset, and Vulnerability Evaluation (OCTAVE)
7.5.5 OCTAVE Allegro
7.6 Technical risk management analysis methods
7.6.1 Vulnerability Scanning
7.6.2 CIS Critical Security Controls
7.6.3 HITRUST Common Security Framework (CSF)
7.6.4 MITRE ATT&CK
7.6.5 Mitre D3FEND
7.6.6 Penetration Testing, Red Teams, Blue Teams, and Purple Teams
7.7 Risk assessments, risk management plans, and risk registers in the healthcare management process for Health Information...
7.7.1 OCTAVE FORTE for Health Information Exchange networks and modern needs
7.7.1.1 Step 1—Establish risk governance and appetite
7.7.1.2 Step 2—Scope critical services and assets
7.7.1.3 Step 3—Identify resilience requirements of assets
7.7.1.4 Step 4—Measure current capabilities and Step 5—Identify risks, threats, and vulnerabilities to assets
7.7.1.5 Step 6—Analyze risks against capabilities
7.7.1.6 Step 7—Plan for response
7.7.1.7 Step 8—Implement the response plans
7.7.1.8 Step 9—Define metrics
7.7.1.9 Step 10—Review, update, and repeat
7.8 Emerging trends
7.8.1 Trusted Exchange Framework and Security
7.8.2 Blockchain/Distributed Ledger Technologies
7.8.3 Decentralized Identifiers
7.9 Summary
Questions for discussion
References
8 Architectures and approaches to manage the evolving health information infrastructure
8.1 Introduction
8.2 The health information infrastructure
8.2.1 The health information infrastructure is an Ultra Large-Scale system
8.3 Supporting the health information infrastructure
8.3.1 Architecture
8.3.2 Transactions
8.3.3 Interoperability
8.3.3.1 Foundational interoperability
8.3.3.2 Syntactic interoperability
8.3.3.3 Semantic interoperability
8.4 Open HIE—a model health information infrastructure
8.4.1 Business domain services
8.4.2 Registry services
8.4.3 Interoperability layer
8.4.4 Structure of the interoperability layer
8.4.5 Core component
8.4.5.1 Security
8.4.5.2 Monitoring/logging
8.4.6 Mediation component
8.4.6.1 Adapters
8.4.6.2 Orchestrators
8.5 Benefits of the OpenHIE interoperability layer
8.6 Emerging trends
8.7 Summary
Questions for discussion
References
9 Syntactic interoperability and the role of syntactic standards in health information exchange
9.1 Introduction
9.2 Defining syntactic interoperability: definition and need
9.3 Common syntactic standards relevant for health information exchange
9.3.1 Health Level Seven International standards
9.3.1.1 HL7 v2 messaging standard
9.3.1.2 HL7 CDA document standard
9.3.1.3 Fast Healthcare Interoperability Resources
9.3.2 Digital Imaging and Communications in Medicine
9.3.3 National Council for Prescription Drug Programs
9.3.4 X12 standards in health care
9.4 How standards are developed for health care
9.5 How syntactic standards are used and supported in the real world
9.5.1 Implementation guides
9.5.2 Interface engines
9.5.3 Health information exchange services
9.5.3.1 Integrating the Healthcare Enterprise
9.5.3.2 eHealth Exchange
9.6 Emerging trends
9.6.1 Transferring bulk data: Flat FHIR
9.6.2 Clinical decision support and quality measurement: Clinical Quality Language
9.6.3 Research: OMOP Common Data Model
9.6.4 Clinical information models: the Gender Harmony Project
9.6.5 Trusted Exchange Framework and Common Agreement
9.7 Summary
Questions for discussion
References
10 Standardizing health care data across an enterprise
10.1 Introduction
10.2 Role of terminologies in health care
10.3 Standard terminologies in health care
10.4 Selection of standard terminologies for health information exchange
10.5 Current use of standard terminologies
10.6 Mapping
10.6.1 Equivalence
10.6.2 Mapping process
10.6.3 Fitness for purpose
10.7 Terminology Services
10.7.1 Implementation of Terminology Services
10.7.2 Terminology Service support
10.7.3 Evaluation of Terminology Services
10.8 Emerging trends
10.9 Summary
Questions for discussion
References
11 Shared longitudinal health records for clinical and population health
11.1 Introduction
11.2 Shared longitudinal records for clinical health
11.3 Shared longitudinal records for population health
11.3.1 Population health dashboards and indicators
11.3.2 Disease surveillance
11.3.3 Medical research
11.4 Implementation
11.4.1 SHR implemented as an EHR
11.4.2 SHR implemented as a database
11.4.2.1 Relational database management system
11.4.2.2 Not only SQL DBMS
11.4.3 HMIS implemented as data analysis platform
11.4.4 Data quality challenges to implementation
11.5 Emerging trends
11.5.1 Postpandemic infrastructure redesign
11.5.2 Learning health systems
11.5.3 Social determinants of health
11.6 Summary
Questions for discussion
References
12 Client registries: identifying and linking patients
12.1 Introduction
12.2 Patient identifiers
12.3 Unique patient identifiers
12.3.1 Attributes of ideal identifiers
12.3.2 Social security number
12.3.2.1 Biometric identifiers
12.3.3 International unique patient identifiers
12.4 Client registries
12.5 The Enterprise Master Patient Index
12.6 Data quality
12.7 Metadata and standards
12.8 Algorithmic matching
12.8.1 Basic concepts of matching
12.8.2 Field comparison methods
12.8.3 Blocking
12.8.4 Decision models
12.8.4.1 Deterministic matching
12.8.4.2 Probabilistic matching
12.8.4.3 Machine learning–based linkage methods
12.8.4.4 Statistical matching
12.8.4.5 Hybrid methods of record linkage
12.8.4.6 Privacy preserving record linkage
12.8.5 Linkage quality metrics
12.8.6 Biases in record linkage
12.8.7 User interface
12.9 Emerging trends
12.9.1 Data quality
12.9.2 Biometrics
12.9.3 Hybrid matching algorithms
12.9.4 Location intelligence
12.9.5 Patient engagement
12.9.6 National strategic framework for identity matching
12.10 Summary
Questions for discussion
References
13 Facility registries: metadata for where care is delivered
13.1 Introduction
13.2 Facility registry background
13.3 Implementation of a health facility registry
13.4 The value of facility registries
13.4.1 Care coordination
13.4.2 Quality improvement
13.4.3 Public health
13.5 Components of a facility registry
13.6 Facility registry functionality
13.7 Data specification
13.7.1 Signature domain
13.7.2 Service domain
13.8 Creating unique identifiers
13.8.1 World Health Organization candidate identifiers
13.8.1.1 Integer codes
13.8.1.2 Facility codes
13.8.1.3 Universally unique identifiers
13.8.1.4 The Tanzanian facility identifier number
13.8.2 Other candidates for creating unique identifiers
13.8.2.1 Object identifiers
13.8.2.2 National provider identifiers
13.8.2.3 Health industry numbers
13.9 Data sources for constructing the master facility list
13.10 An example from the US social security administration
13.11 Mapping disparate facility data
13.12 Emerging trends
13.13 Summary
Questions for discussion
References
14 Health worker registries: managing the health care workforce
14.1 Introduction
14.2 Need for coordinated health care worker data
14.3 Health worker registries
14.4 Health worker registries within a health information exchange
14.5 Existing minimum data sets
14.6 Creation of minimum data sets
14.7 Standards to support the minimum data set
14.8 Emerging trends
14.8.1 A health care provider directory for the United States
14.8.2 Health worker registries support operational health system needs
14.8.3 Registries for community health workers
14.9 Summary
Questions for discussion
References
15 Healthcare finance data exchange: toward universal health coverage
15.1 Introduction
15.2 Role of claims in health information exchange to achieve universal health coverage
15.2.1 What is claims processing?
15.3 Claims processing in the United States and Europe
15.3.1 United States
15.3.2 Europe
15.3.2.1 Claims processing in the Netherlands
15.4 Claims processing systems in Low-and-Middle Income Countries
15.4.1 Open-source Insurance Management Information System
15.4.2 Implementation of openIMIS
15.4.2.1 Nepal
15.4.2.2 Tanzania
15.4.2.3 Chad
15.4.2.4 Cameroon
15.4.2.5 Democratic Republic of Congo
15.5 OpenHIE and claims processing
15.5.1 Proposed function of health financing in OpenHIE Architecture
15.5.2 Interoperability use cases
15.6 Summary
Questions for discussion
References
16 Evidence base for health information exchange
16.1 Introduction
16.2 Methods
16.3 Evidence base for the effect of Health Information Exchange on health outcomes
16.3.1 Period 1 (January 1980–May 2014) overview
16.3.2 Period 2 (June 2014–June 2017) overview
16.3.3 Period 3 (July 2017–December 2021) overview
16.3.4 Descriptive characteristics from contemporary literature
16.3.5 Evolution of evidence of the effects of Health Information Exchange over time
16.3.6 Gaps in the current evidence
16.4 Conclusion
Questions for discussion
References
17 Measuring the value of health information exchange
17.1 Introduction
17.2 The spectrum of evaluation
17.2.1 Evaluation categories
17.2.1.1 Formative evaluation
17.2.1.2 Summative evaluation
17.2.1.3 Scientific research
17.2.2 Domains of evaluation
17.3 Developing an evaluation plan
17.3.1 The evaluation team
17.3.1.1 Evaluation methodology
17.3.1.2 Health care operations
17.3.1.3 Technical implementation
17.3.1.4 Clinical care
17.3.1.5 Project management
17.3.1.6 Patient (consumer) representation
17.3.2 Defining goals, objectives, and stakeholders
17.3.3 Identifying potential measures
17.3.4 Designing the evaluation
17.3.5 Data sources
17.3.6 Assessing feasibility of evaluation measures
17.3.7 Finalizing the plan
17.4 Dissemination of findings
17.4.1 Strategies for success
17.5 Emerging trends
17.5.1 A growing evidence base
17.5.2 Return on investment
17.6 Summary
Questions for discussion
References
18 Leveraging HIE to facilitate large-scale data analytics
18.1 Introduction
18.2 Foundations for analytics
18.3 Analytical maturity
18.4 Analytical approaches
18.4.1 Descriptive analytics
18.4.2 Predictive analytics
18.4.3 Prescriptive analytics
18.5 Drivers of analytics in health systems
18.6 How does analytics support promoting interoperability and reporting goals?
18.7 How can HIOs provide real-time analytics to meet population health goals?
18.7.1 HIOs as enablers of analytics
18.7.2 HIOs as a provider of analytics-as-a-service
18.7.3 HIO use of a vendor-supplied analytics platform
18.7.4 Conveying value
18.8 Barriers to analytics
18.8.1 Low-to-middle-income countries
18.8.2 Barriers to HIE analytics
18.8.2.1 Financial
18.8.2.2 Data collection
18.8.2.3 Methodology selection
18.8.2.4 Organizational
18.9 Impact of HIE architecture models on analytics
18.10 Emerging trends
18.11 Summary
Questions for discussion
References
19 Health information exchange: incorporating social and environmental determinants of health into health information exchange
19.1 Introduction
19.2 Section 1. Defining social determinants of health
19.2.1 Economic stability
19.2.2 Education access and quality
19.2.3 Healthcare access and quality
19.2.4 Neighborhood and built environment
19.2.5 Social and community context
19.3 Section 2. The role of health information exchange in social determinants of health
19.4 Section 3. Incorporation of social determinants of health into health information exchange
19.4.1 Data collection and storage
19.4.1.1 Data management
19.4.2 Aggregate/population data
19.4.3 Person-level data
19.4.4 Metadata/hierarchies
19.5 Emerging trends
19.6 Summary
Questions for discussion
References
20 Cross-border Health Information Exchange to Achieve World Health Outcomes
20.1 Introduction
20.2 Cross-border Health Information Exchange
20.2.1 United States
20.2.1.1 Patient-Centered Data Home
20.2.2 Africa
20.2.3 Europe
20.2.3.1 Legal and financial aspects
20.2.3.2 Towards the European Health Data Space (TEHDAS)
20.2.4 Latin America
20.2.4.1 Brazil & French Guiana
20.2.4.1.1 Study area
20.2.4.1.2 Data sources & Definition of Cross-Border Malaria Cases
20.2.4.1.3 Data Harmonization System
20.3 Summary
Questions for Discussion
References
21 Future directions for health information exchange
21.1 Introduction
21.2 A unified approach to nationwide exchange
21.2.1 Federal support for health information exchange
21.2.2 The health information exchange landscape
21.2.3 Nationwide exchange
21.2.4 Trusted Exchange Framework and Common Agreement basics
21.2.5 Trusted Exchange Framework and Common Agreement launch
21.2.6 Considerations for the future
21.3 An emerging challenge: usability of interoperability
21.3.1 The emerging challenge of interoperability usability
21.3.2 Potential solutions
21.3.3 Key challenges to data integration
21.3.4 Considerations for the future
21.4 International policies impacting health information exchange
21.4.1 Joint Action Towards the European Health Data Space
21.4.2 African Union health information exchange efforts in support of public health
21.4.2.1 A framework for health information exchange in Africa
21.5 Models of health information exchange postpandemic
21.5.1 Why evolve health information exchange into a public utility?
21.5.2 What is a public health data utility?
21.5.3 A disruptive model for health information exchange
21.5.4 Advantages for public health data utilities
21.5.5 Challenges to public health data utilities and the future
21.6 Conclusion
Questions for discussion
References
22 The Indiana Health Information Exchange
Major themes
22.1 Introduction
22.2 Context
22.3 The Indiana Health Information Exchange
22.3.1 Organization
22.3.2 Community engagement
22.3.3 Use
22.3.4 Financial model
22.3.5 Technical approach
22.3.6 Privacy and confidentiality
22.3.7 Services
22.3.7.1 OneCare
22.3.7.2 PopCare
22.3.7.3 GovCare
22.3.7.4 Other services
22.3.8 Lessons learned
22.4 Summary
Questions for discussion
References
23 Using health information exchange to support public health activities in Western New York: a case study
23.1 Introduction
23.2 Background and context
23.3 Health information exchange and public health
23.3.1 Uses of health information exchange in public health
23.3.2 Public health emergencies
23.3.3 Reporting to public health agencies
23.3.4 Public health alerting
23.3.5 Clinical care
23.3.6 Public health services
23.4 Intervention, planning, and assessment
23.4.1 Uses of HEALTHeLINK to provide public health services
23.4.1.1 COVID-19
23.4.1.2 Chlamydia
23.4.1.3 Gonorrhea
23.4.1.4 Syphilis
23.4.1.5 Hepatitis surveillance
23.4.1.6 Rabies investigations
23.4.1.7 Foodborne illness outbreaks
23.4.1.8 Tuberculosis
23.4.1.9 Quality audits to track infection control in hospitals
23.4.1.10 Tracking nursing home and long-term care infections
23.4.1.11 HIV investigation and contact tracing
23.4.2 Challenges
23.4.3 Contributors to success
23.5 Summary
Lessons learned
Questions for discussion
References
24 Creating a 21st century health information technology infrastructure: New York’s Health Care Efficiency and Affordabilit...
Major themes
24.1 Introduction
24.2 Background: the Health Care Efficiency and Affordability Law for New Yorkers Capital Grant Program
24.3 Case study: the evolution of health information exchange organizations in New York State
24.4 HEAL NY Phase 1 (2005–08)
24.5 HEAL NY Phase 5 (2007–10)
24.6 HEAL NY Phases 10, 17, and 22 (2009–14)
24.7 New York State’s evolution during the period of federal action: HITECH Act and Meaningful Use Stages 1 & 2 (2008–14)
24.8 The current state of health information exchange in New York State
24.9 Summary
Questions for discussion
References
25 Use of Health Information Exchanges for value-based care delivery and population health management: a case study of Mary...
25.1 Introduction
25.2 Value-based care and Accountable Care Organizations
25.2.1 Background
25.2.2 Accountable Care Organization concept
25.2.3 Value-based metrics
25.2.4 Role of population health
25.2.5 Accountable Care Organization’s information technology needs
25.2.6 Potential role of Health Information Exchanges for Accountable Care Organizations
25.3 Role of Maryland’s Health Information Exchange in value-based care
25.3.1 Background
25.3.1.1 Mission and history
25.3.1.2 Types and number of stakeholders
25.3.1.3 Governance
25.3.1.4 Information flow and architecture
25.3.2 Maryland all-payer waiver program and CRISP
25.3.3 CRISP’s population health IT services
25.3.3.1 Hospital readmission reporting and prediction
25.3.3.2 Population health management services
25.3.3.3 Other ongoing or planned population health services
25.4 Conclusion/summary
Questions for discussion
References
26 Health information exchange—the value proposition: a case study of the US Social Security Administration
26.1 Introduction
26.2 Theoretical models for examining the value of health information exchange
26.2.1 Socio-technical systems approach
26.2.2 Interorganizational systems
26.2.3 Value proposition
26.2.4 Conceptual framework
26.3 Background and context
26.3.1 Nationwide Health Information Network
26.3.2 MedVirginia/Bon Secours1
26.3.3 US Social Security Administration
26.4 Case study
26.4.1 The challenge
26.4.2 Opportunity
26.4.3 The case: examining social versus economic value propositions
26.4.4 The case: examining the blended value collaboration enactment framework
26.4.5 Social Security Administration
26.4.6 MedVirginia
26.4.7 ONC
26.4.8 The Sequoia Project/eHE—an update
26.5 Summary
Questions for discussion
References
27 Health information exchange–enhanced care coordination: implementation and evaluation of event notification services in ...
Major themes
27.1 Introduction
27.2 Background
27.3 Event notification
27.4 Context
27.4.1 Overview of the two Veterans Health Administration medical centers
27.4.2 Health information exchange in the Veterans Health Administration
27.4.3 Strengths and weaknesses of existing health information exchange in the Veterans Health Administration
27.5 Implementing event notification services in the Veterans Health Administration
27.5.1 Our community-based health information exchange partners
27.6 Experiences and lessons learned
27.6.1 Characteristics of Veterans with non-Veterans Health Administration care
27.6.2 Impact of event notification services alerts on timely follow-up
27.6.3 Impact of event notification services alerts on hospital usage
27.6.4 Impact of event notification services alerts combined with a care transitions intervention
27.6.5 Barriers to using event notification services
27.6.5.1 Contents of the event notification services alert message
27.6.5.2 Logging into the health information exchange network
27.6.5.3 Capacity concerns around scaling event notification services
27.6.6 Recommendations for future event notification services development and implementation
27.6.7 Use of event notification services to support COVID-19 response within Veterans Health Administration
27.7 Future directions for event notification services
27.8 Summary
Questions for discussion
References
28 Facilitating HIE in Denmark: the story of MedCom, a Danish health information organization
Major themes
28.1 Introduction
28.2 Background
28.2.1 Denmark
28.2.2 The Danish health system
28.2.3 Digital health in Denmark
28.3 Health information exchange in Denmark
28.3.1 Digital health infrastructure
28.3.2 Security and user authentication
28.3.3 A pragmatic approach to engineering HIE solutions
28.3.3.1 View only
28.3.3.2 Messaging
28.3.3.3 Deep integration
28.3.3.4 Value proposition
28.4 HIE adoption and use
28.5 Keys to success for Denmark
28.5.1 Supportive health policy
28.5.2 Innate desire to achieve consensus and build community
28.5.3 MedCom the white hat organization
28.6 Challenges and barriers to HIE and data use
28.6.1 Failed efforts at interoperability and HIE
28.6.2 Using data for research and quality improvement
28.6.3 Limited awareness of HIE and multiple channels for access can equal confusion
28.7 Future directions
28.7.1 Setting Denmark on FHIR
28.7.2 Quality reporting for specialty providers
28.7.3 Enabling notifications for data harmonization
28.7.4 Care coordination
28.7.5 Saving and parsing discharge summaries
28.7.6 Electronic patient data suitcases
28.8 Summary
Questions for discussion
References
29 Addressing data needs for national HIV programs using HIE: case studies from Ethiopia and Nigeria
Major themes
29.1 Introduction
29.2 Background
29.2.1 Working toward adoption of health information exchange in countries
29.2.2 Health information exchange and global human immunodeficiency virus program data needs
29.2.3 Key health information exchange technical considerations
29.3 Case studies
29.3.1 Case Study 1 Establishing a HIV viral load data exchange through an HIE in Ethiopia
29.3.1.1 Background
29.3.1.2 Viral load request and return of results before health information exchange
29.3.1.3 Viral load data exchange using health information exchange
29.3.1.4 Development and implementation process
29.3.1.5 Challenges
29.3.2 Case Study 2 A National Data Repository as the enterprise data store in an HIE in Nigeria
29.3.2.1 Background
29.3.2.2 Data exchange
29.3.2.3 Development and implementation process
29.3.2.4 Barriers and enablers in the health information exchange implementation
29.3.2.5 Monitoring health information exchange and future plans
29.4 Summary
Discussion questions
Disclaimer
References
30 Health information exchange in Taiwan: multiple layers to facilitate broad access and use of data for clinical and popul...
Major themes
30.1 Introduction
30.1.1 The Republic of China (Taiwan)
30.1.2 Taiwan’s health system
30.2 Background on Taiwan’s national health insurance system
30.2.1 Enrollment and universal coverage
30.2.2 Financing and administration
30.2.3 Accessibility and comprehensive coverage
30.2.4 Information technology
30.2.5 Information systems management
30.3 Health information exchange to support the NHI
30.3.1 The NHI IC card network
30.3.2 The NHI MediCloud System (NHI-MCS)
30.3.3 EEC health information exchange
30.3.3.1 Organization
30.3.3.2 Regulation
30.3.3.3 Stakeholders engagement
30.3.3.4 Technical approach
30.3.3.4.1 EEC HIE structure
30.3.3.4.2 Evaluation and subsidization of the EMR uploads
30.3.3.4.3 Content and semantic standards
30.3.3.4.4 Gateway installation environment requirements for the EEC
30.4 Security and privacy across the NHI system
30.4.1 Security
30.4.1.1 Electronic signature and access control
30.4.2 Privacy
30.5 Comparison of the NHI IC Card, Medi-Cloud, and EEC HIE Networks
30.6 Results and lessons from two decades of HIE in Taiwan
30.6.1 MediCloud network impact
30.6.2 EEC network utilization and performance
30.6.3 Facilitators of HIE in Taiwan
30.6.3.1 Universal health access and identifiers
30.6.3.2 Policy and breadth of data that compels use of HIE network
30.6.3.3 Engagement of consumers in HIE access
30.6.4 Barriers and lessons learned
30.7 Future directions
30.7.1 Using services online by virtual NHI IC card
30.7.2 Using NHI cloud technology to tackle pandemic
30.7.3 Building up systemwide interoperability
30.7.4 Evolving standards to FHIR
30.7.5 Incentivizing provider use of EEC
30.8 Summary
Discussion questions
References
31 Israel’s national HIE network Ofek: a robust infrastructure for clinical and population health
Major themes
31.1 Introduction
31.2 Background
31.2.1 Israel
31.2.2 The Israeli health system
31.3 Origins of health information exchange in Israel
31.4 Technical infrastructure of Ofek
31.4.1 Security Protocols
31.4.2 Commercial connection
31.5 Utility and use of HIE in Israel
31.5.1 Functions and services
31.5.2 Critical HIE research by Israel
31.5.3 Ofek facilitated national COVID-19 pandemic response
31.6 Facilitators and barriers to HIE in Israel
31.6.1 Facilitators of HIE
31.6.1.1 The Israel national identity number
31.6.1.2 Opt out consent model
31.6.1.3 The virtual patient object
31.6.1.4 Strong support from the Israeli Ministry of Health
31.6.2 Barriers to national HIE adoption and use
31.6.2.1 HIE remains a directive, not a requirement
31.6.2.2 Separate but equal edge servers
31.6.2.3 No lingua franca
31.6.2.4 Limited patient experience
31.6.2.5 Investments in other technologies and maintenance of legacy systems
31.7 The next generation of HIE in Israel—Eitan
31.8 Summary
Questions for discussion
References
32 Bringing health information exchange to the Middle East and North Africa: the case of Malaffi in Abu Dhabi
Major themes
32.1 Introduction
32.2 The United Arab Emirates
32.3 The healthcare system in Abu Dhabi
32.4 Health information exchange initiatives in the UAE
32.5 Case highlight: Malaffi
32.5.1 Background
32.5.2 Goals
32.5.3 History and milestones
32.5.4 Mission, vision, and values
32.5.5 Policies, technologies, and process
32.5.6 Project scope
32.5.7 Organization
32.5.8 Community engagement/providers
32.5.9 Finances
32.6 Usage and impact of health information exchange
32.6.1 Progress statistics
32.6.2 Surveys and testimonials
32.6.3 Clinical adoption results
32.7 Challenges
32.7.1 Challenge 1—business case sustainability
32.7.2 Challenge 2—aggressive connection timeliness
32.7.3 Challenge 3—provider readiness to connect
32.7.4 Challenge 4—electronic medical record data quality and digital maturity
32.7.5 Challenge 5—interoperability and data standardization
32.7.6 Challenge 6—mutual responsibilities of participants
32.8 COVID-19 and Malaffi
32.8.1 Background
32.8.2 Solutions deployed
32.8.2.1 Urgent access to Malaffi to frontline workers
32.8.2.2 Malaffi COVID-19 Module
32.8.2.3 Vaccination Module
32.9 Improving interoperability and data standardization
32.10 New frontiers in population health management
32.11 Summary and the next chapter for Malaffi
Questions for discussion
References
Index