A new patient with a history of diabetes schedules a comprehensive eye exam with your office. Before the start of the exam, wouldn’t it be nice if you received a summary of the patient’s medical history, one that was already inserted directly into your exam workflow? Think of the time that would be saved, even if this summary included only the patient’s problem list, medication list, and allergy information.

Health Information Exchanges (HIEs), organizations that provide services to enable the electronic and secure sharing of health-related information, make this information and much more available to your office. An HIE enables doctors, nurses, labs, and other medical providers to securely access their patient’s electronic health information quickly, 24/7/365, to improve the speed, quality, safety, and cost of patient care.

HIEs act as a central repository where all of a patient’s health information resides and can be shared among all the providers on a patient care team, even if the providers are in different health systems or different offices. When a participating provider finishes an exam, the results of the exam are sent to the HIE. When another participating provider prepares for an exam, the patient’s updated and accurate health information can be automatically populated into the patient’s electronic exam forms.

The process of collecting information for the HIE often starts at the time of new patient check-in. Specifically, the patient is presented with a form, entitled Authorization to Disclose Health Information. By signing the form, the patient may authorize disclosure of the “Entire Health Record” or “Other,” which means any portion of the patient record. The patient can opt-in or opt-out of sharing their protected health information with an HIE. To stop sharing patient data, a patient would need to complete, sign and return an opt-out form to their care provider.

HIE BENEFITS

Because providers send patient information, such as exam results, directly to the HIE at the time of care, HIEs can give all participating providers complete patient information that is more accurate than information obtained by asking patients and relying on their memory of their medical history. Additional benefits, according to The Office of the National Coordinator for Health Information Technology (ONC), include:

• Rapid information sharing
• Improved patient safety by reducing medication and medical errors
• Increased efficiency; saving time by eliminating unnecessary paperwork and handling
• Better care coordination by providing caregivers with clinical decision support tools for effective care and treatment
• Reduced cost by eliminating duplicate tests and unnecessary procedures
• Improved quality of care
• Facilitation of communications among providers
• Reduced need for patient to deliver medical records
• Nationwide exchange of information

In addition, HIEs facilitate a provider’s contribution to the team delivery of care.

The following scenarios demonstrate benefits of HIEs to patients:

While on vacation in Aspen, Colo., a woman injures her shoulder and sustains a concussion while skiing. Through the HIE, the treating physician can review the patient’s medical record — including for example, any previous injuries or eye and vision issues — prior to providing treatment. The “real-time” diagnosis and care plan is electronically transmitted and immediately available to the patient’s primary care provider in her home state.

A second, more common, case represents a rapidly growing trend in patient expectations: A patient who has diabetes schedules an eye exam with a new optometrist. If this patient receives the majority of their care in a system where providers share the same EHR (such as a hospital system), then the patient likely expects all providers will automatically have access to their entire patient history without the need to fill out forms, even if it is the patient’s first visit with the provider.

Providers who continue to ask patients a number of health questions, or provide a questionnaire on a clipboard in the waiting room, may appear behind the times. Most certainly, a patient would be more impressed when you say, “I see that you have had diabetes for the past eight years, and you are treating it with…”

HIES HERE AND NOW

Sound futuristic? It isn’t. For example, Civitas, a national nonprofit collaborative organization, represents more than 81 HIEs, whose members use information technology and trusted relationships in their service areas to enable secure authorized exchange of patient information among health care providers.

HIEs provide services, including timely access to important patient data, when and where it is needed. Examples of some documents available through an HIE include: consults, medical history (including health problems), allergies, medications, immunizations, health problems, lab results, EKG tracing, Continuity of Care Documents (CCDs), radiology and pathology reports, discharge and ED summaries, and other data embedded in EHRs. Behavioral health and psychiatric data may be exchanged, but these require a separate authorization from the patient.

DATA SECURITY

Of course, the patient’s protected health information (PHI) must be adequately protected in any system, and like any entity that stores and shares PHI, HIE members must follow all federal and state data security regulations, including those specified in HIPAA.

(While a discussion of data security is beyond the scope of this article, general guidance on data security can be found in the ONC’s “Guide to Privacy and Security of Electronic Health Information” at bit.ly/3yBCKR4 .)

AN OPPORTUNITY FOR EYE CARE

Despite the benefits, few optometric providers currently participate in HIEs. Why? According to one health care IT analyst, it is because most eye care providers are not aware of the existence or value of HIEs. However, providers associated with a hospital may be more aware of HIEs. Each state in the nation is covered by at least one HIE. By performing a simple web search, providers can identify available HIEs within their state.

Most HIE’s charge a minimal yearly fee of several hundred dollars to join. The No. 1 requirement is that the provider utilize Direct Secure Messaging, which is already built into every “certified” EHR. (Direct Secure Messaging utilizes identity-proofing to ensure messages are only accessible to the intended recipient, per HIPAA protection regulations, according to the ONC.)

Visit the ONC’s website, HealthIT.gov , to learn more about the basics of HIEs, including how to get started with an HIE.

If you do decide to join an HIE, you will be taking an important step in bringing the same benefits to your practice that other medical providers are already enjoying. Also, if your local PCPs know that you are participating with an HIE, you will likely increase referrals from them. OM

DR. SNYDER launched HealthCare Registries, LLC in 2013. The registry extracts and analyzes “real-time” clinical outcomes data from provider electronic health records. For nearly 40 years, he owned and operated practices in several settings, including a very successful private practice and a franchise. In addition, Dr. Snyder founded several eye care-related businesses.

DR. LIPSON is recently retired from his position as an optometrist/associate professor at University of Michigan, department of Ophthalmology and Visual Science. He has published peer-reviewed clinical research studies on ortho-K, vision-related quality of life, myopia management, and new lens designs. A consultant to the specialty contact lens industry, he authored the book “Contemporary OrthoKeratology.”