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Four of the biggest challenges faced by health information organizations


Four health information organizations recently convened to discuss their challenges and successes in interoperability stability and infrastructure.

Four health information organizations recently convened to discuss their challenges and successes in interoperability stability and infrastructure.

A health information organization is government-led, nonprofit group that creates interoperability and EHR exchanges on a state, regional and national level. They usually are helmed by a board of leaders from different sectors of healthcare.

These organizations were awarded $2.5 million in 2016 from the Office of the National Coordinator for Health Information Technology (ONC) to advance admission, discharge, and transfer (ADT) notifications to providers, facilities, and care managers within their states and to neighboring states.

Here are four of the biggest challenges they encountered, based on findings released in an ONC



1. Rules restricting information sharing

The Delaware Health Information Network is an HIO that  aimed to grow its ADT notifications with providers, hospitals, and consumers within Delaware. It ran into challenges communicating with other health information organizations that had more restrictive agreements limiting the type of data being shared and the types of providers, hospitals, and patients allowed to receive the data.

For example, one HIO required patients and providers to have had a face-to-face encounter in the last 18 months in order for the patient’s data to be sent to the provider. In response to this issue, DHIN built new technology to proactively ask providers in Delaware their National Provider Identifier numbers to verify patient-provider relationships.

2. Behavioral health disconnects

Reliance eHealth Collaborative, an HIO,  and the Oregon Health Authority had three goals

  • Expand ADT notifications with high-risk patients in Oregon;

  • Collaborate with the Emergency Department Information Exchange and PreManage to connect with hospitals in Oregon, Washington, and California; and

  • Allow providers in Washington and Northern California access to Oregon Health Authority’s statewide Flat-File Directory.

The collaborative reported difficulties creating robust alerts that reported on clinical concepts and not just a single health event. The organization also faced barriers connecting with behavioral health EHRs. “Reliance reported that it might have been able to alleviate some of the challenges of working with behavioral health EHRs had it started working with these vendors earlier in the program,” according to the ONC report.

Next: Conflicting priorities 



3. Changes in partners’ priorities

The Rhode Island Quality Initiative is an HIO that had a goalto expand ADT and care management alerts and its statewide common provider directory specifically with the Yale New Haven Health System in Connecticut. The organization also sought to expand ADT alerts to a healthcare system in Massachusetts, but due to a shift in priorities, the system pulled out of the project.

However, it was able to share continuity of care documents with one hospital within the health system, based off a redesign of the hospital’s care management work flow and processes. RIQI also work with ambulatory sites to adopt health information exchange services and is integrating Yale New Haven Health System provider data into its statewide common provider directory.

4. Incomplete data due to EHR changes

The Utah Health Information Network (UHIN), is an HIO that aimed to reach smaller rural and urban clinics within Utah via email, and it aimed to connect with long-term post-care acute facilities with ADT notification. Outside of Utah, it aimed to connect health information organizations in Idaho, Nevada, and Nebraska. It created a provider directory  based on Fast Healthcare Interoperability (FHIR) technologies.

The organization faced issues connecting with neighboring states due to different states having different and/or competing priorities, and receiving incomplete data from hospital systems due to changes in EHR systems.

“In addition, UHIN spent more time and effort than originally anticipated to encourage participation in the provider directory exchange among states and clinics. Initially, some state and clinical staff did not understand the benefit of such a directory. However, through continued outreach and education with these staff, UHIN has been able to add valuable provider information to the ADT alerts that are currently sent, providing the right data at the right time,” the ONC reported.




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