1. Greenberger, Mari MPPA

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Over the last decade or so, it's clear that the nurse's role has changed. Nurses truly play a pivotal role in all aspects of care delivery. Whether at the bedside, in the community, or while electronically documenting care in a heath delivery organization, nurses are critical to meeting the demands of today's healthcare environment. It's difficult to argue with the idea that healthcare has become an increasingly complex landscape for providers to navigate, including embracing the adoption and use of electronic health records (EHRs). It nearly takes a "village" to ensure that patients are receiving the best possible care and clinicians have access to the information they need at the right time and place.

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As a nurse manager, you can appreciate the shifting nature of healthcare as you embrace change in your organization every day. Whether it's an issue involving a member of your frontline nursing staff, a change in budgetary needs, or your work to optimize existing resources and ensure a culture of safety, you can relate to working through challenges to find the most appropriate solution.1 Sometimes the solution isn't always straightforward and it may take a few times to get it right, but you recognize that the journey to arrive at the right decision or path forward always brings great learning and growth opportunities for everyone involved. The same can be said about our nation's path toward achieving meaningful health information exchange (HIE).


What it means

The HIE landscape is also evolving and continues to remain fluid over time. You may be asking, "What does HIE mean?" According to the HIMSS Dictionary of Healthcare Information Technology Terms, Acronyms, and Organizations, Third Edition, HIE provides the capability to electronically move clinical information among disparate health information systems and maintain the meaning of the information being exchanged. The goal of HIE is to facilitate access to and retrieval of clinical data to provide safe, more timely, efficient, effective, equitable, patient-centered care.2 HIE is also used by public health authorities to assist in analyzing population health.


HIE comes in several flavors, so it's important to clarify if we're referring to it as a noun or verb. When used as a verb, HIE means the sharing action between any two or more organizations that have an executed business or legal agreement outlining the agreed-upon technology and applied standards that are used for the purpose of electronically exchanging health-related data. As a noun, HIE can refer to an entity such as a quality information organization-an Agency for Healthcare Research and Quality funded statewide or regional community or a private/enterprise information exchange. When used as a noun, HIE may also be referring to a health information organization (HIO).3 An HIO is an overarching organization that governs the exchange of health-related information among multiple health delivery organizations according to nationally recognized standards. The purpose of an HIO is to perform oversight and governance functions for multiple HIE entities.


The HIE concept has been around for several decades and has been given various names, such as community health information network (CHIN) and regional health information organization (RHIO) to name a few. (See Table 1.) At the highest level, HIE-both the verb and the noun-provides many crucial benefits for providers, patients, and hospitals, including:

Table 1: Get to know... - Click to enlarge in new windowTable 1: Get to know the acronyms

* enhancing care coordination through communication between providers


* ensuring access to the right information, at the right time, for providers, patients, and all other stakeholders


* improving efficiency and reliability through the elimination of unnecessary paperwork and providing caregivers with clinical decision support tools


* improving quality and safety through the reduction of medication/medical errors and near misses.3



What it can do

I'm sure you can appreciate that the relationship between HIEs and EHRs is an active one and continually evolving in nature. Many benefits that HIEs and HIOs can offer won't be realized without the data being collected by members of the care team and stored in an EHR. For example, care coordination is a dynamic process that requires data access across platforms and among healthcare providers in real time. Many EHR systems, despite being developed by the same company, don't talk to each other, creating information gaps and delays that minimize the potential value of the EHR and connected HIE community. Other benefits of HIE come from use of a record locator service, which enables the creation of a continuous community record about a patient, and a master patient index, which facilitates patient identification across multiple provider settings.3


Some benefits of HIE remain to be realized. For example, HIEs or HIOs will become essential components of the development and operation of Accountable Care Organizations and Patient-Centered Medical Homes.4 As these new value-based care models progress, the role of nurses and the use of HIE will continue to advance and adapt to the ever-changing healthcare environment that surrounds us. Care delivery is increasingly complex and nuanced, yet nurses are the backbone to any care team and the linchpin of care coordination and patient safety efforts.


Nurse managers have a strong understanding of what it takes to communicate with multiple stakeholders: frontline nurses, social workers, pharmacists, technicians, and patients and their families. You're also aware that you can't provide the same information or level of detail, or use the same communication style, with each of these different stakeholders. Typically, you'll modify your approach and the information you share based on the intended audience.5 For example, when you're discussing a patient-care issue with one of the nurses or pharmacists on your unit, you'll likely explain it in different terms than you would when talking with a patient or a family member.


A meaningful future

Like nurses, HIEs are tirelessly working to improve how we communicate and provide the most valuable services in the right way for their various customers (such as providers, patients, payers, and public health agencies) within their state, region, or community. There isn't a one-size-fits-all approach to HIE, just as there isn't a single way to provide the best care for your patients or emulate a leadership style with your team. Like nurse managers, HIEs and HIOs need to monitor their progress and evaluate their results to find opportunities to improve, learn from their mistakes, and ultimately ensure that secure and meaningful data exchange is occurring where and when it's needed to create healthier individuals and communities.




1. Agency for Health Research & Quality. Patient safety primer: safety culture. [Context Link]


2. Healthcare Information and Management Systems Society. HIMSS Dictionary of Healthcare Information Technology Terms, Acronyms and Organizations. 3rd ed. [Context Link]


3. Healthcare Information and Management Systems Society. FAQ: health information exchange (HIE). [Context Link]


4. Robert Wood Johnson Foundation. Health information technology in the United States, 2015: transition to a post-HITECH world. [Context Link]


5. Cipriano PF. Move up to the role of nurse manager. [Context Link]


6. Healthcare Information and Management Systems Society. The business case for interoperability and health information exchange. [Context Link]