Helpful Information About Health Information Exchanges (HIE’s)

The prospects of a fully integrated healthcare system are truly exciting. While patients’ expectations and HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More capabilities may truly never completely align, the exchange of a patient’s health data within a health organization, or regionally, among aligned providers, have tremendous potential to improve patient care and satisfaction.

This white paper will discuss six different aspects of HIEs, including:

Six Different Aspects of HIEs

Health Information Exchange: What’s the Motivation?

Now that the majority of innovative healthcare organizations have invested the capital, time and effort to install electronic medical records, many are looking to fully leverage the technology and meet Meaningful Use requirements by connecting to an HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More. According to eHealth Initiative’s 2011 Report on Health Information Exchange: FAQs, there were 255 HIEs in 2011, an increase of 9% from 2010. A majority (70%) of existing HIEs are private, yet just 24 claimed to be sustainable.

There are several reasons why HIEs are a logical next step for health providers who have implemented EMRElectronic Medical Record (EMR), as defined in Defining Key Health Information Technology Terms (The... More systems, including qualifying for Meaningful Use or serving as a precursor or test case for connecting to a future Accountable Care Organization (ACOAn Accountable Care Organization (ACO), according to the Centers for Medicare & Medicaid Services (C... More). Whatever the motivation, both examples can mean significant revenue for the organization, in addition to improved efficiency of patient care:

  • The earlier a health care organization qualifies for Meaningful Use Stage 1 requirements, the more financial benefit the provider or health organization will receive as part of the Medicare Electronic Health Records (EHRElectronic Health Record (EHR), as defined in Defining Key Health Information Technology Terms (The ... More) incentive program. For Medicare-eligible hospital systems, qualifying for Meaningful Use in 2011 means receiving millions of government dollars earlier than if they qualify at a later date.
  • Care providers who are members of an ACOAn Accountable Care Organization (ACO), according to the Centers for Medicare & Medicaid Services (C... More, as defined in the Affordable Care Act, can potentially earn significant Medicare rewards for the realized cost savings from bundled payments and meeting pre-defined quality of care benchmarks. While EMRs are not required of all ACOAn Accountable Care Organization (ACO), according to the Centers for Medicare & Medicaid Services (C... More providers, they are required to perform an analysis of the ACO’s overall patient care metrics against the 32 benchmarks set by the U.S. Department of Health and Human Services.HIEs also have the potential to provide cost savings to connected organizations in the forms of increased productivity, avoidance of duplicate medical procedures, and the resulting shared savings as a result of payment by episode of care.

While a positive return on investment is always the key motivator for organizations to make costly business moves such as installing EMRs or paying to connect to HIEs, the good news for patients is that both Meaningful Use requirements and ACOs share a common end result – improving the quality of patient care.

Regardless of personal beliefs on the merits of a connected health care industry, the reality for health IT professionals is that HIEs are forming in every state. There is, however, uncertainty about the different forms of HIEs and what challenges health organizations likely will face when trying to exchange data within a HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More.

Architecture Types

This section provides an overview of three common public HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More architecture types: centralized, federated and hybrid models. Additionally, many larger health organizations have built private HIEs to effectively share patient data between member hospitals, labs and their referring physicians.

First, a quick snapshot that displays an example of how data might flow within the three types of public HIEs, starting at the local level (Centralized), moving to the state level (Federated) and ending at the national level (Hybrid), or NwHIN (Nationwide Health Information Network). The Centralized Model is the most common architecture for private HIEs.

Centralized Model

Centralized Model with a Regional Central Authority

Centralized HIEs have a single Clinical Data Repository (CDRClinical Document Repository (CDR) enables hospitals to build a life-long health record environment ... More) that is maintained by the HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More authority, which is usually governed by representatives from each member hospital. The centralized architecture can be utilized on a regional basis, for example, by hospital systems located in the same metro area.

Each member hospital electronically transmits agreed upon patient health information to the CDRClinical Document Repository (CDR) enables hospitals to build a life-long health record environment ... More, where it is securely stored and continually updated via interfaces that are connected directly to each hospital’s patient data repository, or health information system (HISHospital Information System (HIS) is the main system in a hospital used by most caregivers. Sends AD... More). Through these interfaces, patient data flows to the central authority, updating the appropriate records, and also back to each member hospital when the data is requested, which is usually done upon patient admit using a pre-defined set of unique patient identifiers, such as social security number or last name.

The most interoperable HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More architecture, the centralized model is also the most expensive to establish and maintain because it requires a large upfront investment in technology in the form of servers, which need to be monitored and stored in a secure, separate location.

Additionally, each organization must have a fully functional EHRElectronic Health Record (EHR), as defined in Defining Key Health Information Technology Terms (The ... More and utilize CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More documents.

Federated Model

A Federated HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More model consists of a collection of clinical data repositories that are remotely located. In this example, Centralized HIEs agree to provide the overreaching state or central authority with their unique patient identifier information, which is stored in the statewide HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More patient registry, or record locator service. In a Federated HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More (as opposed to Centralized HIEs) patient data is not stored in a centralized, accessible location. Patient information continues to be stored locally with the Regional Central Authority in this example.

To retrieve patient data, member organizations send query messages to the HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More patient registry. The patient registry contains a “virtual roadmap” of where patient health records are located, searchable by a combination of unique patient identifiers such as a combination of name, social security number, and others.

Federated Model with a State Central Authority and Regional Central Authorities

When a record is located in the registry, the state central authority transmits the record’s physical location back to the requesting organization. The requesting organization then must request the patient information from the facility where it is located. The facility storing the information can transmit the data to the requesting organization via secure e-mail, secure web servicesWeb services are a standardized way of integrating applications. Using open standards, businesses ca... More, or through a VPN connection.

The Federated HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More model is considered less interoperable than the Centralized HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More because it does not allow a simple exchange of information between facilities’ EHRElectronic Health Record (EHR), as defined in Defining Key Health Information Technology Terms (The ... More systems. The requirement that a central record locator service track numerous, duplicate health records at multiple remote locations increases the complexity of locating a patient’s complete health history and determining which information is the most up to date.

Hybrid HIEs

This national HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More architecture type could represent a combination of HIEs participating in the EHRElectronic Health Record (EHR), as defined in Defining Key Health Information Technology Terms (The ... More/HIE InteroperabilityInteroperability refers to the ability of two or more systems or components to exchange information ... More Workgroup, a federally backed initiative to develop and test the standards and processes needed to create a national exchange of health information. In addition, the Nationwide Health Information Network, typically referred to as NwHIN, is working to lay the foundation for our national health system.

In this example Hybrid Architecture model, Federated HIEs request data similar to regional HIEs, but the location of records across states would be performed at a national level. In this example, a national authority, such as the NwHIN, is storing a limited amount of information at the national level possibly for population health reasons. This example assumes that all participating state HIEs are structured using the Federated model.

Several hospital systems across the country have created a private HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More system that includes internal databases and referring physicians. Many ACOAn Accountable Care Organization (ACO), according to the Centers for Medicare & Medicaid Services (C... More structures are supported with private HIEs. Most likely a private HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More will utilize the Centralized HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More model since there is a single, private governing organization. A private HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More is a good way for health systems to create internal interoperabilityInteroperability refers to the ability of two or more systems or components to exchange information ... More that will allow them to easily connect to HIEs, state databases and, later, the NwHIN.

HIE Communication Methods

Model of Communications Between a Hospital and External Providers

Although not a complete list, there are four common methods health organizations use to send and receive Continuity of Care Documents (CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More) within an HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More:

TCP/IP over VPN

TCP = Transmission Control Protocol

Supported Communication Methods

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 HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More.

When using this communication method, CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More documents are immediately transmitted to the HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More based on trigger events at the point of care, such as a patient discharge. This consecutive updating of a patient’s data gives all HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More members access to a patient’s current health record.

At Corepoint Health, we believe that health organizations can most effectively connect to a public HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More over VPN using an integration engine. Integration engines eliminate the need for extensive point-to-point scripting and programming to configure messages containing CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More documents for exchange within an HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More.

Secured Web Services

This communication method allows HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More members to send and receive patient data via secure communications over the internet. Secured web servicesWeb services are a standardized way of integrating applications. Using open standards, businesses ca... More is also very interoperable because the HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More 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 HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More using industry standard methods, such as IHEIntegrating the Healthcare Enterprise (IHE) is an initiative by healthcare professionals and industr... More profiles. The CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More will be wrapped with metadata that will be stored in the HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More registry, and the document itself will be stored in the HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More repository.

Organizations can use an interface engineAn interface engine can transform or map the data to the receiving application’s requirements whil... More or a custom HISHospital Information System (HIS) is the main system in a hospital used by most caregivers. Sends AD... More interface to configure and send/receive CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More data to the HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More using web servicesWeb services are a standardized way of integrating applications. Using open standards, businesses ca... More.

Secured Ftp

FTP = File Transfer Protocol

Organizations connecting to an HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More 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 HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More solution, but it does enable the sharing of patient data, thus meeting Meaningful Use electronic data exchange requirements as specified in Stage 1.

Secure E-Mail

Utilized as an entry-level communication method for HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More involvement, secure e-mail is the direct transmission of one provider’s patient data to another requesting HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More provider via secure e-mail. Frequently called the “push” method of HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More data exchange because the owner of the information “pushes” the data to another location.

The Direct ProjectThe Direct Project was launched by the ONC within Health and Human Services (HHS) on March 1, 2010. ... More initiative provides specifications for the use of secure e-mail in transporting patient health information. The primary Direct ProjectThe Direct Project was launched by the ONC within Health and Human Services (HHS) on March 1, 2010. ... More specification, the Applicability Statement for Secure Health Transport, is a required communication method for Meaningful Use Stage 2.

Typically, this is how the exchange works: Provider A contacts the HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More requesting to find information about a specific patient. The HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More might have a portal that returns locations (i.e., other HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More providers) that have information on the specific patient. Provider A will then request that patient’s information directly from the providers identified by the HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More. Once the request is received by the other providers, they will securely email the data to Provider A.

Physician and Patient Portals

HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More architecture types and communication methods typically only involve IT staff. Physician and patient portals bring the HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More end result to individuals, both physicians and patients.

Merriam-Webster defines portal in different ways, but this definition is most applicable to an HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More: “A site serving as a guide or point of entry to the World Wide Web [HIE] and usually including a search engine or a collection of links to other sites arranged especially by topic.”

So, what exactly do portals have to do with HIEs?

Not all physicians will be able to connect to a regional HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More for various reasons, such as lack of an advanced EMRElectronic Medical Record (EMR), as defined in Defining Key Health Information Technology Terms (The... More or he or she may be a specialist not involved with routine or emergency care. These physicians will have the ability to access their regional HIE’s physician portal to view a specific patient’s treatment history, providing valuable health data that may be useful prior to performing a procedure.

For patients, portals link them to the process of health data exchange. In the future, the patient’s total health record – regardless of where the care was received – will be viewable in a patient portal. This is extremely valuable because patients will have the ability to correct errors in the health record if they exist and be reminded of previous care they have received.

A portal is also an access point for both patients and health providers to a convenient communication platform, which differs among portal vendors. Some portals allow only basic communication in the form of offering patients the ability to schedule or reschedule appointments, request a prescription refill and complete paperwork prior to their next appointment.

Other, more robust portals – especially those built to meet Meaningful Use Sections 170.304(h) and 170.306(d) – allow patients to access clinical summaries and electronic copies of their health information. In terms of offering a true communication method between patient and physician, some portals give the patient the option to send a text (SMS) message or an email directly to hisHospital Information System (HIS) is the main system in a hospital used by most caregivers. Sends AD... More or her physician.

Portals represent tremendous advances in opening the doors of communication between patients and our caregivers. Giving patients the ability to bypass the patient calling tree and to directly communicate with the provider about billing questions or simple prescription refills will likely improve patient satisfaction. The portal will also give the provider better access to the patient, with the ability to send email reminders that it is time to schedule an annual physical or information about valuable health resources for specific chronic diseases.

An accurate patient health record is vital for quality care because it can prevent repeat examinations and provide caregivers with knowledge of pre-existing medical conditions that may actually save a patient’s life. Portals truly have the potential to directly connect patients to their care, which is the true reason behind health information exchange.

Despite Momentum, HIE Sustainability a Concern

Few in healthcare argue that exchanging patient health records electronically is a bad idea. HIEs around the country are already touting the benefits of their services, namely a reduction in unnecessary patient trauma and unnecessary costs.

In 2011, there were 255 HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More organizations in the U.S., yet only 24 reported that they were financially sustainable. In other words, there are 231 HIEs that are currently not making enough revenue to cover operating expenses.

Many of these HIEs are able to continue operation due to HHS grants and because member healthcare organizations are willing to risk a short-term financial loss because they believe the HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More will gain widespread provider acceptance, which will eventually help them recoup early losses through several cost savings measures and future government reimbursement incentives (e.g., bundled payments, quality of care benchmarks).

Local physician practices are slow to adopt EMRElectronic Medical Record (EMR), as defined in Defining Key Health Information Technology Terms (The... More systems due to significant costs that can outpace Meaningful Use reimbursements and, some would argue, because they have no financial incentive to enthusiastically adopt a new healthcare system that moves away from the fee-for-service model they have successfully used for generations. From strictly a business sense, it’s logical for them to ask “What’s in it for me?” before investing hundreds of thousands of dollars on an EMRElectronic Medical Record (EMR), as defined in Defining Key Health Information Technology Terms (The... More system just so they can connect with the local HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More.

HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More directors must prove to the referring physician community that patients overwhelmingly want a system that securely exchanges their medical data, and that belonging to such a system will provide the physicians a return on their investment of an EMRElectronic Medical Record (EMR), as defined in Defining Key Health Information Technology Terms (The... More system with external connectivity, HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More fees, and all the additional technology and staff required to make it functional.

Through Meaningful Use and HHS, the government is also playing a major role in pushing all providers toward a modern, electronic medical system. However, time is of the essence for HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More sustainability and there are no government mandates that require participation in an HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More, regardless of the obvious benefits it has for patient care. Meaningful Use Stage 2 objectives may push eligible professionals to utilize an HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More, but those rules are not effective until 2014.

Obstacle: Patient Education

An HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More can have 100% provider participation, but it is worthless if it doesn’t have patient data to exchange. It’s imperative that HIEs receive patients’ consent to exchange their health data with other HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More provider members. HIEs currently employ two different models: the patient opt-in model or the patient opt-out model.

It’s pretty simple. When visiting their provider, patients are given two options about their patient data, usually in the form of a check box on paperwork that is completed during check in, which sounds similar to the following simplified examples:

Example 1: Check here if you approve Memorial Hospital to share your electronic health record with local health providers who are members of the State Health Information Exchange. (Opt-in Model)

Example 2: Check here if you DO NOT want Memorial Hospital to share your electronic health record with the State Health Information Exchange. (Opt-out Model)

HIEs have found that the Opt-out Model has a higher success rate because the patient must take the extra action to exclude their record. The Opt-in Model requires an extra educational component about the benefit of HIEs for the patient, either in the form of printed materials or by verbal communication from the office staff.

The Opt-in Model also has other obstacles to gain patient consent because there is an inherent distrust by many Americans to allow their information to be used for any purpose because it only reminds them of junk e-mails, identify theft, and telemarketing phone calls.

So, despite great interest in HIEs, they have many obstacles to overcome before they can claim to be successful. However, numbers never lie – if operating HIEs continue to report progress on cost savings and patient safety, then it is unlikely provider organizations will want to be on the outside looking in. Patients realize the health system is rapidly changing and soon they’ll have the choice to go to a provider who has invested in modern technology in an effort to provide better patient care.

The Building Blocks of HIEs: A Glossary of Terms

One thing to keep in mind when reading about HIEs and how they operate is that the terminology is not consistently used by health IT professionals, which only complicates the learning process. For example, you’ll notice below that the definitions for Document Registry and Record Locator Service are very similar, and you’ll often find they are used interchangeably in discussions and in publication. Hopefully these terms provide a foundation to help you better understand the complicated, and always changing, world of health information exchange.

Clinical Data Repository (CDRClinical Document Repository (CDR) enables hospitals to build a life-long health record environment ... More): The database in which patient data is stored. Regardless of the HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More architecture type, each member organization maintains their own CDRClinical Document Repository (CDR) enables hospitals to build a life-long health record environment ... More. Centralized HIEs have a CDRClinical Document Repository (CDR) enables hospitals to build a life-long health record environment ... More that houses a redacted version of the complete patient medical record, which is easily accessible by all member organizations.

Communication Backbone: The method by which data is transmitted within an HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More. Communication methods include secured email, secured FTP, secured Web servicesWeb services are a standardized way of integrating applications. Using open standards, businesses ca... More, and TCP/IPTransmission Control Protocol/Internet Protocol (TCP/IP) is a low-level communications protocol used... More via VPN connection. HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More components that need to be regularly updated may include: Master Person Index, Record Locator Service, CDRClinical Document Repository (CDR) enables hospitals to build a life-long health record environment ... More, and Portals.

Direct ProjectThe Direct Project was launched by the ONC within Health and Human Services (HHS) on March 1, 2010. ... More: The Direct ProjectThe Direct Project was launched by the ONC within Health and Human Services (HHS) on March 1, 2010. ... More was launched by the ONCOffice of the National Coordinator for Health Information Technology (ONC) – Located within the Of... More within Health and Human Services (HHS) on March 1, 2010. It was initially called NHINNationwide Health Information Network (NHIN) is one of the ONC‘s major initiatives. As defined by ... More Direct. The object of the Direct ProjectThe Direct Project was launched by the ONC within Health and Human Services (HHS) on March 1, 2010. ... More is to replace the use of faxes, phones, and paper transactions with a simple and secure point-to-point communication over the Internet. The Applicability Statement for Secure Health Transport is the primary Direct ProjectThe Direct Project was launched by the ONC within Health and Human Services (HHS) on March 1, 2010. ... More specification and uses the SMTP e-mail protocol with secure S/MIME attachments and x509 certificates.

Document Registry:  A document registry is best described as the “patient index” of each patient who has health information accessible by the HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More and contains information where that information is stored. The health standards organization Integrating the Healthcare Enterprise (IHEIntegrating the Healthcare Enterprise (IHE) is an initiative by healthcare professionals and industr... More) has worked at defining document registries, which are available in evolving Web-services technology.

Master Person Index (MPI): Stores, and cross references, the unique IDID is a coded value data type. The value of such a field follows the formatting rules for a ST field... More for every patient in the HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More.

Portal: Provides independent, personal access to the HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More for the treating physician or for the patient to view and access information, which can include hospital paperwork, appointment information and personal health information.

HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More Participant Identity Management: HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More member providers and networks are verified by node level identity management, as defined by IHEIntegrating the Healthcare Enterprise (IHE) is an initiative by healthcare professionals and industr... More Audit Trail and Node Authentication standards. Node level identity management establishes security measures that, together with the HIE’s security policy and procedures, provide patient information confidentiality, data integrity, and user accountability.

Record Locator Service (RLS): Keeps track of all records for a single patient. The location of the RLS varies depending on the HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More architecture type. Centralized HIEs have a common CDRClinical Document Repository (CDR) enables hospitals to build a life-long health record environment ... More that houses basic patient demographic information. Typically, a centralized HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More member issues a patient query to the RLS, which locates the correct patient’s data and sends the location back to the requesting organization – all within the centralized HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronical... More.

In Federated and Hybrid HIEs, all patient data is maintained by and “lives” in the member’s CDRClinical Document Repository (CDR) enables hospitals to build a life-long health record environment ... More (not in a centralized location). When the RLS receives a patient query, it must relay all participant organizations, rank the responses, and then return the information to the original requester.

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