HIEx(TM): The Shared Community Health Record
Author: Mary M. Crimmins
June 2007
Health information technology (HIT) typically refers to electronic health records in a physician’s office or in a hospital system. Health information exchange (HIE) refers to the business of Regional Health Information Organization (RHIOs) that are seen as the primary building blocks for the National Health Information Network. As such, RHIOs will be responsible for maintaining a patient centric health record that captures information from multiple points of care into a central view or record. HealthLink Miami Valley has established the HealthLink RHIO as the West Central Ohio’s focus for health information exchange. The HealthLink RHIO is administered by the Wright State University Center for Healthy Communities (CHC).
At the nexus of the HealthLink RHIO is HIEx™, a web-based system that was developed using federal (HRSA) funds to provide a central data repository for a shared community health record. The core data set for HIEx™ is built on the Continuity of Care Record (CCR), which is currently the only national standard for clinical health information exchange (ASTM E2369-05). The CCR provides accurate clinical, demographic and administrative data for a specific patient. HIEx™ currently houses demographics, contacts, referrals, notes, scanned documents, medications, immunizations, diagnoses, procedures, and eligibility data stored at both the individual and household levels.
HIEx™ is used by CHC Community Health Advocates and Dayton Public School Nurses to coordinate healthcare and referrals for supportive services. When a child presents in the school clinic, the nurse can access information on primary care physician, immunizations, medications, diagnoses, procedures and emergency contacts. The School Nurse can record the clinic visit, symptoms and care given and can request assistance from CHC Community Health Advocates with accessing health care and other needs of the family.
The HealthLink RHIO has partnered with an Ohio based commercial company, HTP, Inc., which provides a service to facilitate insurance inquiries for eligibility and transaction routing services for all HIEx™ users. HTP, Inc. developed the transaction services operated through the UHIN RHIO for the state of Utah, and has had a customer base primarily of decentralized health information technology and exchange systems. HIEx™ is the first central data repository to use HTP, Inc. services, serving as a model for non-distributed health information technology and exchange. The literature shows that adoption of functionalities with financial benefits generally exceeds adoption of those with safety and quality benefits, particularly in reasonably new HIT markets. HealthLink RHIO members anticipate that including the functionalities provided by HTP, Inc. will contribute to organizational utilization of HIEx™.
HIEx™ offers a best practice community solution for sharing individually identified health and human services data across multiple provider settings by housing the CCR in a secure central data repository that sources all bits of data, uses role based access, provides security through a virtual private network (VPN), and provides a full HIPAA audit trail. HIEx™ also implements the National Library of Medicine’s Unified Medical Language System (UMLS) which provides a standard language to populate the clinical data elements specified by the CCR. This includes presentation and integration of SNOMED-CT®, ICD-9 codes, RXNORM and other systems to represent the concepts that provide meaning to the language of biomedicine and health. HIEx™ uses .NET and other Microsoft® technologies and has adopted an open source philosophy in the construction of the system. HIEx™ provides a solution that facilitates the capture and presentation of individual and household level data for authorized users in health and human services. Wright State University owns the code for HIEx™ and has a patent application pending to protect the intellectual property, ensuring that the product can continue to be offered as a public utility.
HIEx™ is offered on a subscription basis to health and human service organizations in the greater Dayton Ohio area. Formal data sharing and business associate agreements must be in place to legally establish the relationships supporting the shared community health record.
Students in the Raj Soin College of Business have been working with HIEx™ managers to develop on line tutorials for system users.
Mary M. Crimmins, M.A., CPEHR, CPHIT
HIEx™ Business Manager & Research Associate Center for Healthy Communities Boonshoft School of Medicine Wright State University
937.775.1122 (office)
