Health Information Exchange (HIE) focuses on the mobilization of healthcare information electronically across organizations within a region or community. HIE provides the capability to electronically move clinical information between disparate health... Series. Part 5 of 6.
So far in this series I’ve attempted to lay the groundwork to give you a basic understanding of Health Information Exchanges. Now that we’ve defined the What and the Why , this post will discuss How health organizations actually exchange health data with the HIE.
Although not an exhaustive list, there are four common methods health organizations use to send and receive Continuity of Care Documents (Continuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the Health Level Seven and American Society for Testing Materials (ASTM) to “harmonize” the data format between ASTM’s Continuity of Care Record (CCR)...) within an HIE:
- Transmission Control Protocol/Internet Protocol (TCP/IP) is a low-level communications protocol used to connect hosts on the Internet or a network. TCP/IP connections are established between clients and servers via sockets. TCP/IP is stream-oriented ... over VPN
- Secure Web services are a standardized way of integrating applications. Using open standards, businesses can communicate without in-depth knowledge of one another’s systems, beyond the communication protocol. Because all communication is XML-based, web se...
- Secure FTP
- Secure E-mail
I’ll describe each communication method, from most interoperable to least interoperable.
TCP/IP over VPN
TCP = Transmission Control Protocol
IP = Internet Protocol
VPN = Virtual Private Network
This model allows computers to communicate over a secure private network and provides end-to-end connectivity, with specifications on how data should be formatted, addressed, transmitted, routed and received at the destination. This method is the most-connected (interoperable) way to exchange health data in an HIE.
When using this communication method, CCD documents are immediately transmitted to the HIE based on trigger events at the point of care, such as a patient discharge. This consecutive updating of a patient’s data gives all HIE members access to a patient’s current health record.
At Corepoint Health, we would obviously encourage health organizations to use an integration engine to connect to a public HIE via this communication method. Integration engines eliminate the need for extensive point-to-point scripting/programming to configure messages containing CCD for exchange with an HIE. Given that, it is possible for interface specialists to create a point-to-point connection with the HIE using TCP/IP over VPN.
Secured Web Services
This communication method allows HIE members to send and receive patient data via secure communications over the internet. Secured web services is also very interoperable because the HIE data is updated in real time based on trigger events.
Once a patient’s health data is updated by a provider and the trigger is set, that patient record is published to the HIE using industry standard methods, such as Integrating the Healthcare Enterprise (IHE) is an initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information. Visit the IHE website. Synonyms: Integrating the Healthcare Enterprise profiles. The CCD will be wrapped with metadata that will be stored in the HIE registry, and the document itself will be stored in the HIE repository.
Organizations can use an interface engine or a custom HIS interface to configure and send/receive CCD data to the HIE using web services.
FTP = File Transfer Protocol
Organizations connecting to an HIE via secured FTP can send patient data in batches, or one document at a time. Batches are typically sent once each day. This obviously is not a real-time HIE solution, but it does enable the sharing of patient data, thus meeting Meaningful Use electronic data exchange requirements as specified in Stage 1.
Utilized as an entry-level communication method for HIE involvement, secure e-mail is the direct transmission of one provider’s patient data to another requesting HIE provider, via secure e-mail. Frequently called the “push” method of HIE data exchange because the owner of the information “pushes” the data to another location.
Typically, this is how the exchange works: Provider A contacts the HIE requesting to find information about a specific patient. The HIE might have a portal that returns locations (other HIE providers) that have information on the specific patient. Provider A will then request that patient’s information directly from the providers identified by the HIE. Once the request is received by the other providers, they will securely email the data to Provider A.
Topics in this HIE series include:
Part 1: Health Information Exchange: What’s the Motivation? 
Part 2: Architecture Types 
Part 3: Despite Momentum, HIE Sustainability a Concern 
Part 4: The Building Blocks of HIEs: A Glossary of Terms 
Part 5: HIE Communication Methods 
Part 6: HIE Physician and Patient Portals