By Clinical Informatics News Staff

August 7, 2015  | Health information exchanges (HIEs), whether regional efforts funded by the government or proprietary systems set up by large healthcare provider networks, seek to share information about patients across different providers and record systems. While this is valuable to all types of care, the success of an HIE is perhaps best measured in the context of emergency care, which needs to not only retrieve information relevant to treatment, but to do so quickly, and in a way that is visible to physicians and prioritizes urgent recommendations and contraindications.

In the Annals of Emergency Medicine, a team of eight emergency physicians from diverse institutions has published a set of high-priority items for improving the use of HIEs in emergency situations. The workgroup was convened by the American College of Emergency Physicians, in support of a proposed national HIE that would have much greater reach, and perhaps more relevant standards, than current piecemeal exchanges.

“Significant changes are needed to support a system of effective national HIE that can rapidly and efficiently yield useful health information to health care providers in emergency departments,” Jason Shapiro of the Icahn School of Medicine at Mount Sinai, a co-author of the recommendations, said in a press release.

Some of the items highlighted by the workgroup require technical solutions. For example, the authors strongly recommend that data collected through HIEs be accessible in a single click from the local electronic health record, and that there be automatic systems in place to both notify physicians that HIE information is available, and to crawl through that information for anything that should result in a notification or warning. The authors also recognize the need for interoperable data standards that allow health records to communicate, and recommend that standards-setting organizations prioritize data fields commonly used in emergency care.

Other items are more cultural or policy-oriented in nature, including a proposal that emergency physicians be involved in early pilot programs of HIEs. A few are even likely to be politically controversial: the workgroup supports, though does not insist on, a national patient identifier to make record retrieval easier, and also suggests that consent and privacy protocols operate differently in emergency situations, to ensure that physicians have rapid access to critical but sensitive information like HIV status or psychiatric treatments.

“The ultimate goal is a nationwide health information network that will allow physicians quick access to their patients’ medical histories without compromising their privacy,” said another co-author, Jeffrey Nielson of Summa Akron City Hospital, in the same release. “It is a tall order for sure, but not an impossible one.”