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The eHealth Exchange and Interoperability in HIE

The eHealth Exchange and Interoperability in HIE
11 July 2018

HIE | Health Information Exchange

Technology is taking over. There is no denying that. If you go to a mall, a movie theater, a sporting event, or any other place where people gather, you would see people, ranging from age 6 to age 80+, having a phone in their hands. With this influx of technology and the widespread use of it and how it has made life easier, they’ve been integrated into settings that previously were technologically challenged. 

Technology is also taking over in other, more important sectors, such as healthcare. But the complexities and requirements are different here. With the inception of digital technologies in a clinical setting, there has been a rapid proliferation of standards that regulate how this information is stored, used and accessed. These standards represent an essential part of maintaining data integrity and patient confidentiality. However, they can be complex, multi-faceted and confusing in today’s interconnected health information exchanges.

The Nationwide Health Information Network (NHIN), created in 2004 by the Office of the National Coordinator for Health Information Technology, sought to provide a framework for ensuring that health information exchanges over the internet are secure. The NHIN officially became the eHealth Exchange in 2012, but its goals remained the same throughout the transition. Toward this end, the eHealth Exchange provides a comprehensive set of standards, services and policies. These standards encompass several different elements, including:

  • Definition of data elements – This includes identifying what content can be collected and exchanged.
  • Data interchange formats – These formats refer to the encoding of data elements, document architectures to structure the data elements during the exchange and information models that identify the relationships among the data contained in a message.
  • Terminology – These are the terms and concepts that describe, classify and code the data elements and the relationships between the terms and concepts.
  • Knowledge Representation – This relates to the methods for electronically presenting medical literature, clinical practices and other essential data used for decision-making.
  • eHealth Exchange Standards – Essential in Today’s Clinical Information Environment

Given the gravity of patient data safety, the fallout from violating HIPAA, as well as the essential need for interoperability, any health information platform needs to pay strong attention to the standards required on this network. It currently reaches all 50 states in the US, 75% of the hospitals in the nation, over 70,000 medical groups, over 3,400 dialysis centers and over 8,300 pharmacies. In addition to this, four federal agencies use the exchange, including the Department of Defense, Veterans Affairs, the Centers for Medicare & Medicaid Services and the Social Security Administration. They represent the vast majority of medical information transactions on a national level, creating the need for any HIE to ensure compliance with the standards and interoperability in order to remain functional in the current clinical data environment.

The shared architecture and standards that are found with the eHealth Exchange boasts several key features. These include:

  • Common Legal Agreements
  • Shared governance
  • Central Contact (no point-to-point agreements necessary)
  • Neutral, representative, equitable governance
  • Technology and vendor neutral (standards-focused)
  • Security model that enables access controls


The NHIW and subsequently the eHealth Exchange, have some concrete applications that function to provide direct and indirect patient care with the hope that it will lead to improved health.

  • Providing the capability for standards-based, secure data exchanges on a national level.
  • Improving the coordination of care across a wide range of different clinical facilities, including hospitals, pharmacies and any other treatment centres.
  • Ensuring access to vital, secure and confidential information at the point of care.
  • Empowering patients with a greater ability to manage and control their personal health information.
  • Reducing the risk of medical errors through detailed information with a lengthy history.
  • Creating information-sharing efficiencies that can lower healthcare costs.

[Read More: How to choose a health information exchange vendor?]

Though the eHealth Exchange represents the largest network that serves as a mechanism for health information exchanges, it will never be the only option. For instance, the governing agency, a non-profit and public-private collaborative, called the Sequoia Project, is committed to the goal of improving the quality and security of health information. In this capacity, it has also taken under its umbrella, the Carequality framework and aligned with the Commonwell Health Alliance. Unlike the eHealth Exchange’s function as a network, Carequality and Commonwell function as a network-to-network trust framework. This allows medical providers on any network to access data on other networks. The standards found with Carequality provide for these disparate systems to still access the critical data they need in a secure manner.

With the proliferation of different HIEs and EHR platforms, the eHealth Exchange and Carequality provide the standards that make interoperability easier and lead to better treatment of patient data. These standards should exist as an essential component in any new digital, medical platform.