Pediatric Informatics: Computer Applications in Child Health (Health ...

31 Communities of Pediatric Care and Practice 401
only occasionally. For CSHCNs, the volume and complexity of record processing
and transfer is time and resource intensive and error-prone for both the sending and
the receiving physician.
To provide quality (safe, timely, effective, efficient, equitable, and patientcentered
3 care through “anytime, anywhere” access to patients’ health information
regardless of the situation (mobile or transient patients and practitioners, displacements
due to disasters or situational changes, etc.), Health Information Exchange
(HIE) has been pursued. HIE is defined as the “electronic mobilization or movement
of healthcare information across organizations within a region or community…while
maintaining the accuracy of the information being exchanged.” 4 “HIE”
also refers to any initiative or organization that performs this function. An HIE
either contains selected health data of its members or provides a means of accessing
it. As of 2007, approximately 130 HIEs were in various stages of formation. 5
Goals for HIEs include:
Clinical goals (e.g., decreasing medical errors arising from insufficient information
at the point of care and facilitating disease management including patientspecific
education)
Public health goals (e.g., improved bio-surveillance and medical research)
Economic goals (e.g., the elimination of the need to repeat tests)
Patient empowerment goals (e.g., patient access to personal health records and
improved health information quality through patient management of their record)
Financial benefits 6 of a standardized national HIE have been estimated at $77.8
billion annually once fully implemented, and this has provided incentive to form
HIEs in both private and public sectors. HIEs have traditionally been nongovernmental
entities, but with federal, state, and local government support. Constituents
and stakeholders of HIEs include physicians, hospitals, payors, employers, laboratories,
public health departments, professional associations, pharmacies, and patients
with leadership originating from any of these groups.
HIEs and the data contained within them are distinct from Medical Homes 7 and
are complementary to them. While Medical Homes collect, centralize, and coordinate
medical data about individual patients through a primary care physician, HIEs
permit pooling, dissemination, and sharing of medical data about many patients
from many providers through a sponsoring organization and infrastructure.
31.4 HIE Types: CHINs, Registries, and RHIOs
31.4.1 Community Health Information Networks (CHINs)
In the 1990s, community health information networks (CHINs) promised that sharing
patient information would be good for patients and would save money and lives.
Most CHINs failed for a variety of reasons, 8 among them technical issues, such
as a lack of a widespread Internet infrastructure, lack of financing, disagreements