Health Information Exchange (HIE) – Is it the right way?

Increasing dissemination and exchange of health information electronically between multiple care providing bodies has led to the emergence of Health Information Exchanges (HIE). General opinion has been that these HIEs will inevitably enhance the quality of care, but newer studies debate whether this is the right way to encourage information sharing across the healthcare community.

Recent research by experts in the industry questions the ability of Health Information Exchanges to operate fully in compliance with Meaningful Use as required by the HITECH Act. Instead, researchers suggest developing a cloud based Health Record Bank.

THE HRSA website defines a health record bank as an “electronic consumer-controlled warehouse that gathers, stores and disseminates patients’ health records. A patient can, for a fee, establish an account with a health record bank. When the patient has new medical information – such as information relating to an upcoming physician’s appointment – their provider can send it directly to the bank. The patient can also submit their own information as well as determine who can have access to review their personal medical records.”

One of the original researchers for this study shared his idea that since Electronic Health Records are usually banked in communities across the country, it would be prudent for patients to share their information on a single platform. Not only would this give them better accessibility, it would give the government a better chance to monitor and analyze the trend or pattern of population health.

Cloud-based banks would perform functions of data maintenance for patients’ electronic health records in different communities throughout the country with a local or regional provider having a separate copy of the records which the patient will be able to transfer to any other provider, if he or she chooses to.

Researchers believe that current health information systems are faulty and unstructured. The crisis in healthcare and the need for urgency in reforms lead the research team to think about better ways to share large amounts of medical information across the community, connecting all stakeholders related to the industry.

One of the main issues with current health information exchanges is that it Is largely based on an assumption that one can get information about any patient from any provider. This is ineffective because if you go to a doctor for information about a patient, the doctor will have to contact some other doctor and ask for that specific information which the other doctor will have to search for first, and then relay the information back to the doctor you are sitting with.

If all the information related to every patient across the country was kept on a single database, without the need to check with other parties, information sharing would become easier, quick and efficient. The dilemma now is that, considerable amount of money has already been spent on health information exchanges across the country. This leaves little desire to look for alternative ways of information sharing and a lack of capital for more research into health record banks.



Healthcare and Social Media: Impact, Issues and Governance

The radical global growth in information and communications technology has given rise to the number of internet users who account for 37% of the world’s total population according to ‘Internet World Statistics’.

With this growth, burgeoning use of social media has also increased which includes collaborative projects such as Wikipedia, blogs and content communities such as Twitter and YouTube, and social networking sites such as Facebook and LinkedIn.

The world has seen the influence of social media on global political and community initiatives which has lead to its widespread recognition and use.

Social media has also influenced the healthcare industry and has widespread implications for its stakeholders. The World Health Organization has pages on social networking websites which share information regarding disease patterns and potential epidemics to its global followers.


Like other industries, social media has had an astounding impact on healthcare. Consumers can now express concerns or share information with healthcare professionals or other consumers through social networking websites. Through social networks, blogs, forums and communities, healthcare providers and consumers can communicate their issues and get immediate responses. According to research, 30% of adults in the U.S have been found to have received help through information found on the internet.

Indeed, social media has spread like wildfire and its outreach has influenced even the busiest individuals such as healthcare professionals. Providers and nurses have the opportunity to stay up-to-date with recent developments in the healthcare industry. Care providers professionals can now interact with others in the industry and share ideas and experiences.

Use of Social Media in healthcare has updated the way patients and care providers can connect. Ramona Nelson, co-author of a book explaining the impact of social media on healthcare states, “Patients are becoming our colleagues. It’s changing relationships and the kinds of questions and services a patient asks for.”


Increased use of social media has provided a new platform where the healthcare community can interact and interconnect, but it has brought with it several risks as well.

Healthcare providers are worried about the credibility of content being shared and used on social media . Since information is shared at such a rapid pace, moderation of healthcare related content is very important so that inaccurate information such as rumors about spreading diseases are dispelled as quickly as possible.

When people are sharing healthcare information on unmonitored social media websites, there is high risk of someone sharing private and confidential company information. This can be done deliberately or by mistake, nevertheless causing significant damage to providers, patients and the company. Such issues usually involve employees sharing confidential information about patients or the employer on social networks like Facebook or Twitter in the form of posts, comments or multimedia.

Other issues consist of disgruntled healthcare employees or patients trying to manipulate, bully and negatively criticize their employers or patients. Such occurrences not only pose risks to the individuals involved in unethical behavior which might lead to divorce with their employers, but also a threat to healthcare organizations who may find their reputation tarnished in the industry.


It must not be forgotten that healthcare professionals are responsible for the confidentiality of patient health information and company privacy laws, which is why the industry leaders in collaboration with regulatory bodies should develop, educate and implement stringent policies regarding healthcare information so that the risks posed by free and open information sharing platforms are minimized. The Royal College of General Practitioners in the United Kingdom recently developed the ‘Social Media Highway Code’ for its GPs to ensure that they meet their professional obligations and protect patient health information.

It is clear to see the vast benefits that the healthcare industry can utilize through responsible usage of social media. The most important thing now is for regulations such as HIPAA and HITECH to include and implement stringent rules governing the use of social media in order to protect all parties involved.



The future of CPOE

Almost everyone in the healthcare industry today is familiar with the term CPOE (Computerized Physician Order Entry), due to a significant increase in its usage over the last few years. Quality patient care is rapidly becoming a priority for providers and this has improved significantly due to a sudden surge in rapid health information exchange possibilities. The benefits of CPOE alone has convinced the healthcare community to become an advocate for its usage.


When a computer is able to allow direct entry of medical orders by an authorized or licensed individual, it is essentially enabling CPOE. In healthcare today, faxing and emailing are no longer the most advanced means of communication available. Providers now transmit healthcare information to other stakeholders such as hospitals and laboratories, by means of CPOE. The physicians can order a particular test for their patients in a few clicks and are able to receive results electronically, streamlining care delivery.

While CPOE is merely a component allowing physicians to order procedures and labs in a matter of seconds, transmission of patient health summary via Electronic Medical Records can make care delivery even more efficient.  Eradicating the use of paper-based records and eliminating handwritten data is of paramount importance for both doctors and patients as valuable time is managed efficiently.
Numerous studies have shown that the use of CPOE decreases errors due to illegible handwriting as well as harmful drug interactions. A recent research supported and funded by the Agency for Healthcare Research and Quality (AHRQ) showed that medical prescription through CPOE has shown to reduce drug related errors by 50%.

Explaining the affect of CPOE on medication errors, the researchers said, “We conducted a systematic literature review and applied random-effects meta-analytic techniques to derive a summary estimate of the effect of CPOE on medication errors. This pooled estimate was combined with data from the 2006 American Society of Health-System Pharmacists Annual Survey, the 2007 American Hospital Association Annual Survey, and the latter’s 2008 Electronic Health Record Adoption Database supplement to estimate the percentage and absolute reduction in medication errors attributable to CPOE. Given this effect size, and the degree of CPOE adoption and use in hospitals in 2008, we estimate a 12.5 percent reduction in medication errors, or 17.4 million medication errors averted in the USA in one year.” The study effectively proves the relationship between CPOE and a reduction in medical errors.

One must not forget that EMR, Clinical Decision Support, CPOE and other patient engagement tools are merely aimed at helping providers making their administrative, clinical operations and eventually the quality of care delivery more efficient. These advancements do not aim to replace the physician, so it is up to the care community to work together and improve the very foundation of a safer, more efficient and reliable healthcare network.