Implementing an effective Health Information Exchange (HIE) system

by Rishi Khanna

Integrating HIE systems_Blanc Labs

There are many avenues for secure electronic data transfer available today. And yet, most Canadians’ medical records are still kept on paper and stored in various medical offices or at the patients’ residences. 

Providers typically exchange information through fax, mail, or by patients bringing their records to appointments. When data is exchanged digitally, it is done through email, which may not always be secure. Also, the information may be in a myriad of file formats that may not be compatible with the medical providers’ systems.  

Electronic health information exchange (HIE) can significantly improve the completeness of medical records and greatly impact the care and treatment of patients. Doctors and caregivers can review details such as current medication, history and tests wholistically during visits. HIE systems can also make information available on time for better decision-making.  

 As a medical provider that has adopted email patient information into their process flow, you might ask: What is the need for transitioning into an electronic health information exchange?  

 The answer is standardization. Once data is standardized, you can seamlessly integrate the patient’s health information into your Electronic Health Record (EHR).  

For example, suppose you have patients with diabetes in your EHR, and you receive lab results electronically and incorporate them into your system. In that case, you can easily generate a list of patients with high blood sugar and schedule follow-ups in advance. 

At Blanc Labs, we have spent the last five years helping Canadian and US healthcare providers with their healthcare interoperability strategies.  An HIE is the first step towards achieving interoperability goals. In this article, I have briefly described how HIE works and it’s key features. I have also attempted to provide an overview of the standard architectural components associated with designing HIE systems, laying them down as a reference architecture that can serve as a blueprint for your organization. 

What is an Electronic Health Information Exchange (HIE) system?

An Electronic Health Information Exchange (HIE) system enables the secure and interoperable exchange of health information between different healthcare organizations and providers. As mentioned earlier, the goal of an HIE is to facilitate the sharing of patient health records and relevant clinical data in a standardized electronic format that improves access for healthcare professionals to use this information for better patient care. 

Some of the key features of an HIE are:  

  • Interoperability: HIEs are designed to support the exchange of health information across various healthcare systems, electronic health record (EHR) platforms, and health IT applications. This ensures that data can be seamlessly shared and understood by different healthcare providers. 
  • Patient Data Exchange: HIEs enable the sharing of essential patient information, such as medical history, allergies, medications, lab results, imaging reports, and other clinical data. This helps healthcare providers have a comprehensive view of a patient’s health, even if they have received care from multiple sources. 
  • Data Security and Privacy: HIEs implement robust security measures to protect patient information and ensure compliance with privacy regulations, such as the Health Insurance Portability and Accountability Act (HIPAA). Patient consent is often obtained before sharing their health information through the HIE. 
  • Coordination of Care: By facilitating the exchange of health information, HIEs support better care coordination among healthcare professionals, leading to improved patient outcomes and reduced duplication of tests and treatments. 
  • Public Health Reporting: HIEs can also be used to aggregate de-identified health data to monitor public health trends, track disease outbreaks, and support population health initiatives. 

What are some of the Electronic Health Information Exchange (HIE) systems available today?

Many healthcare information technology companies offer products with Health Information Exchange (HIE) capabilities. Some of the prominent ones include EPIC, Cerner, InterSystems, and Allscripts.  

Even though some of these products have similar HIE features, healthcare organizations have different needs when it comes to accessing patient data and sharing it in a standardized way with external parties. It is important to understand which HIE system works best for you so you can make informed decisions about your interoperability journey. 

HIE Architecture Components

The main objective of HIE architecture is to gather and store patient health information in a consistent way from various healthcare organizations. This enables authorized healthcare providers to access a complete and uninterrupted patient record. 

The key components of an HIE system are: 

  • Data Sources: The system should be able to integrate data from various sources, such as hospitals, clinics, laboratories, pharmacies, imaging centers, and other healthcare facilities. These sources generate patient data, including electronic health records (EHRs), lab results, radiology reports, medications, allergies, immunizations, and more. 
  • Interface Engines: Interface engines serve as middleware to facilitate data exchange between the various data sources and the HIE. They handle data transformation, validation, routing, and protocol conversion to ensure seamless integration of data from disparate systems. 
  • Data Repository: The heart of the architecture is the data repository, where all the integrated patient data is stored. This repository organizes data in a standardized and structured format to ensure consistency and ease of access. 
  • Master Patient Index (MPI): An MPI is used to maintain a unique identifier for each patient across the different data sources. This ensures that patient records are accurately linked, regardless of variations in identifiers or demographic data. 
  • Terminology Services: To ensure consistency and standardization of data, terminology services are used to map and manage different coding systems, such as SNOMED CT, LOINC, RxNorm, and others. 
  • Patient Portal and Provider Portal: HIEs often need to provide patient portals that allow patients to access their own health records and engage in their care. Provider portals enable authorized healthcare providers to view patient records and contribute to care coordination. 
  • Analytics and Reporting: To support population health management and quality improvement initiatives, HIEs may include analytics and reporting capabilities. This allows healthcare organizations to analyze health trends, identify gaps in care, and measure performance. 

Blanc Labs’ HIE Reference Architecture

In our experience, HIE systems should be viewed holistically and as the foundation of healthcare interoperability, preparing for integration and information exchange within the organization and with external partners as you mature along the interoperability journey. This means planning the data flow from end-to-end. 

This is the framework we recommend for building HIE systems: 

  1.  Standardization – This involves enabling the existing healthcare systems (LIS, RIS, HIS, EHR, EHR etc) to support a healthcare standard like HL7, CCDA, DICOM, FHIR etc. 
  2. Data Ingestion – This refers to establishing tools and infrastructure to ingest raw data for further processing. This generally involves leveraging established systems like interface engines. 
  3. Data Curation & Normalization – At this stage, the data coming from different systems gets normalized across different coding systems (e.g.  LOINC, SNOMED, etc.) as well as mapped to unique patients and physicians using local or national master patient and physician indexes. 
  4. FHIR access of data – Normalized data from the previous phase is now exposed using standard FHIR based API for internal/external applications. 
  5. Applications for FHIR – Various kinds of applications can now access a longitudinal view of patient data from a centralized location hence reducing errors and inefficiencies that will result in improved patient outcomes. 


Blanc Labs HIE Reference Architecture
Blanc Labs’ proprietary reference architecture for HIE

We have experience in integrating with various healthcare systems including EMRs like EPIC, Cerner, MEDITECH, AllScripts etc., and devices such as Apple Watch, blood sugar and blood pressure monitors, image scanning devices, among others.  

A Note about Security & Compliance

HIEs handle sensitive patient health information, so robust security measures, such as encryption, authentication, and authorization mechanisms, need to be implemented to protect patient privacy. Access controls should be enforced to ensure that only authorized healthcare providers can view and access patient information.  

Moreover, data governance policies should be defined to govern data quality, data sharing agreements, consent management, and compliance with relevant privacy regulations, such as HIPAA. 

Getting Started with HIE Systems

Blanc Labs is on a mission to improve end-to-end patient care by building healthcare interoperability solutions that enable accurate, timely and secure patient data access to patients and providers. Our teams utilize a strong and expandable approach to infrastructure that follows industry standards and regulatory requirements to guarantee the privacy and security of patient information. With our knowledge in data integration, data management, and interoperability standards, we enable healthcare providers to fully utilize their data, resulting in well-informed decision-making, personalized care delivery, and ultimately, improved patient outcomes. 

To learn more about how we can help with your interoperability journey, reach me here 

About Rishi Khanna:  

Rishi Khanna_Blanc Labs

VP of Engineering/ Healthcare Practice Lead 

Rishi Khanna is an entrepreneurial technology leader with extensive industry experience in architecting secure and scalable distributed systems using modern on-prem, cloud or hybrid infrastructure. Rishi’s role at Blanc Labs is to drive innovation by developing new offerings for the Healthcare domain, leveraging emerging technologies in the field of Software Engineering, Data, AI/ML, Cloud & DevOps. Rishi also leads Blanc Lab’s InfoSec practice that implements and maintains security compliance, which is essential for developing a high degree of trust with our clients. 

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