As electronic medical record technology continues to gain more and more mainstream acceptance in the health care industry, this new technology has opened the door for new practice management tools intended to improve quality of care and increase provider efficiency. One of those new and emerging tools is the Health Information Exchange (HIE). HIE technology is a primary focal point of the HITECH Act of 2009, legislation driven by a policy to promote provider access to pertinent patient health information through the use of computers, the internet and related technology. The legislation calls for the establishment of a Nationwide Health Information Network (NwHIN), a secured electronic exchange network through which providers can access patient health information, as well as standards, services and policies that may apply to the provider. The ultimate aim is to make it easier for providers to access all pertinent patient health information, so they can make more informed treatment decisions, more closely manage demanding medical conditions, and eliminate inefficiencies like duplication of services, all while reducing operational costs.


Unlike many data storage systems which exist in the form of warehouse-sized servers, the HIE is administered through a secured network over the internet. This network connects computer systems and allows for the secured sharing of health information between the different providers which may treat an individual patient. As a result, when a patient is referred to a new physician, admitted to a new hospital, or involved in an emergency, whoever treats that patient will have immediate access to that patient’s medical records through the HIE, and the delay of otherwise having to deliver the records are avoided.

At this point, HIE is still a work in progress. Part of the HIE implementation strategy involved collaboration with individual states. In an effort to bring the states on board, the Federal Government established the State Health Information Exchange Cooperative Agreement program. This program provides funding for the individual states to implement technology which allows for both statewide and interstate mobility of electronic health information.

Another dilemma in the HIE implementation process is the issue of EMR compatibility. Being that EMR is still an emerging technology, all EMR systems are not yet developed to a point where there is a standardized mode of communication across different software platforms. This would be akin to trying to communicate using different languages. To redesign and/or rewrite the different EMR systems is sure to prove time-consuming and costly for all involved. Furthermore, in addition to being able to communicate across software platforms, EMR must be able to share patient information with the HIE networks. This is done using a patient identifier code. Like a Social Security number, the code would be issued at a national level, and would be recognizable by all EMR systems and HIE networks. There has been some clamor, however, surrounding the use of these government-issued identifier codes. Some have expressed sentiments against allowing the government control over access to these medical, for fear of government meddling in protected health information.

As it stands, a great strides must still be made before HIE becomes a part of everyday practice. Despite opposition, the government continues to move forward in implementing these new policies, and it appears as though HIE will eventually become a reality. There are a number of predictions which attempt to forecast the point at which HIE will come to fruition, some say two years, others say it may take up to a decade. Until then, we will continue to trust the fax machine, the postal service, and our colleagues to make sure medical records get where they need to go.