Emergency doctors: How to fix HIE

Emergency physicians rely on health information exchanges to make decisions about patient care, but HIEs face serious challenges in being truly effective.

"Significant changes in practice and public policies are necessary to support a system of effective national health information exchange that can rapidly and efficiently yield useful health information to clinicians, especially in the emergency care setting," according to a new report, written by a workgroup from the American College of Emergency Physicians, in the Annals of Medicine. "These changes should include support for emergency clinician access to all relevant patient information, in properly summarized understandable form to provide safe, efficient, and effective emergency care."

There are competitive concerns where many provider organizations consider their stewardship and control of the patient data they generate to be a business asset and may be reluctant to share data with competitors.

Leadership concerns exist where there is an absence of models for the advancement of health information exchanges, with no clearly recognized trusted entity in some regions to convene stakeholders. Some programs have been established to address this issue but they are still in pilot stages.

In addition, data from electronic health records are experiencing problems with small data such as data entry errors in a patient's electronic record; coding errors, with a laboratory test being mapped to the wrong standard code becoming exponentially larger with increasing levels of data aggregation. These can lead to big data problems as the level of a nationwide health information network is approached.

"Without significant effort being put forward to improve and ensure the quality of electronic data at the local level, the data that enter a health information exchange may be of limited value," the report said.

Other outstanding issues need to be addressed regarding standards, patient matching, usability, workflow, technology and vendors, and privacy and security.

The workgroup said emergency physicians must participate in regional and federal health information exchange–related activities to ensure that emergency medicine interests are appropriately represented.
Policies must be developed for the standard of care for review and inclusion of health information exchange data in the electronic health record in the emergency care setting, based on best practices to promote liability protection related to health information exchange use.

At the government level, federal legislative and regulatory efforts must support a set of standards for exchange of health information. This effort should include developing and prioritizing data elements related to emergency care, prioritizing emergency medicine–specific user interface and workflow requirements, care standards and protocols for effective integration of health information exchange in EDs should be developed.

Also, local professional groups should participate with health information exchanges to provide appropriate data for emergency physicians and should consider conducting pilot programs with health information exchanges to improve the focus on emergency care.