Implementing health information exchange across healthcare facilities and organizations comes with a unique set of challenges. According to the Agency for Healthcare Research and Quality's recent evaluation of 12 of their Transforming Healthcare Quality through IT projects, common issues include problems with staffing, technical issues and an inefficient governance structure. Below is a list of eight lessons for successful implementation of HIE based on projects studied by the AHRQ.
1. Look for outside funding. Many HIE implementation plans face funding issues due to partners' often-incongruous financial resources. According to AHRQ's analysis of THQIT initiatives, acquiring support from local grants, foundations and private donors are viable solutions for funding HIEs.
2. Make staff retention a priority. Organizations implementing HIEs can maintain a high level of trust and a shared vision if they can preserve a low staff turnover rate. While a reduced staff can increase savings, THQIT projects reported losing staff led to a decrease in productivity during HIE implementation periods.
3. Communicate with stakeholders. According to AHRQ, it is imperative for healthcare organizations implementing HIE to engage in open communication with stakeholders to ensure both sides are comfortable with committing to legal agreements.
4. Use an advisory board to encourage partner and consumer buy-in. An HIE can only be successful if both exchange partners and patients are confident in the HIE's privacy and security measures. According to AHRQ, it is important to foster trust among patients without also inducing liability and business concerns for participating organizations.
AHRQ recommends using an advisory board to present stakeholder concerns to the HIE governing board.
5. Conform to technical standards. AHRQ recommends developing standards of HIE implementation to comply with those of the national trend. Organizations implementing HIE should choose standards associated with successful implementation, typically characterized by open source, non-proprietary software and an expandable, scalable platform. Additionally, implementing an order entry system helps prevent errors, according to the report.
6. Develop health IT evaluation metrics. The development of sustainable health IT metrics during HIE implementation and beyond will provide all participating organizations with the necessary technology and support to connect to the exchange as well as a method to ensure the exchange is functioning correctly for all participants.
7. Know and follow state laws and regulations. In order to avoid violating privacy protection laws, AHRQ emphasizes that it is of critical importance for HIE initiatives to be aware of the relevant state laws before implementing an HIE.
For example, states have different laws regarding the disclosure of health information. Some states require specific consent forms for disclosure that may determine whether the HIE should have an opt-in or opt-out system of engaging consumers.
Healthcare organizations embarking on HIE implementation should also be aware of what the surrounding community wants in addition to what the law requires. In its report, AHRQ states that privacy issues may boil down to ethics, not just the law.
8. Create a flexible timeline. In its evaluation, AHRQ notes that HIE initiatives frequently experienced unexpected delays due to technological and personnel issues. To be successful, the implementation timeline for HIE projects should include some flexibility to allow for unforeseen complications.