In Part 1 Integration between an EHR (Electronic Health Records system) and a HIE (Health Information Exchange), I discussed two important questions that you need find answers for: what data are you exchanging, and does that data need to be represented with standardized values (i.e. code sets). In this post, I’ll provide helpful links to aid you in your integration, and discuss a third question that you will need to answer: what data exchange methodology do you need to use.
Is there one place to go for all standards or guidelines?
The answer, generally, is “no”. One of the biggest challenges to getting started is understanding the fact that any industry guidelines you are likely to find will not necessarily be found on one web site, presented by one overarching authority or even grouped by one consistent effort. There has been more and more consolidation of information as the years have passed, but you will still need to go to many places on the web to find what you need. Why is that? Many of the data exchange initiatives have developed independently over time, under different programming models and goals, and by different entities – sometimes competing public and private interests as well.
Your best bet in getting started is focusing on what type of data you need to exchange, understanding the current guidelines and standards for that type of exchange. Then, dig into those guidelines and discover what it requires for the various pieces of data in that message. Sometimes you are given options between two different code sets. Your decision on which to use will depend on what is already in your EHR system, and what does the HIE expect. In other scenarios, the data lists you use are embedded into the standard and you will only have one choice. Here are some links to common data sets in use today:
Labs and Observations
Other supporting code sets
If you still can’t find what you need, you can start with one of the “top most” authorities – the U.S. Government, specifically the Office of the National Coordinator. This site has many additional launching points for standards, funding, and data exchange initiatives, but will take some time to dig through to get what you need.
What data exchange methodology are you using?
Knowing and understanding HOW you need to exchange data with the HIE in a technical manner is critical. Just like you can receive mail in a variety of ways (USPS to your mailbox, UPS or FedEx to your door), data exchange can be accomplished using many different technologies. You start by understanding how your HIE can receive data. Hopefully, your HIE is following national standards and have adopted an accepted way of exchanging data. One thing you will need to realize is that HIEs accept different types of data in different ways. You may need to support one or more of these methods. Here are some important factors you should ask up front:
- Is the data exchange one-way or bi-directional?
- Does the HIE expose a web service (via SOAP or HTTP) that you can use?
- Can they accept basic TCP messages?
- Do they require a secure connection between your EHR and the HIE? If not, how is the data secured?
- Does the HIE mandate an IHE Profile (Integration the Healthcare Enterprise) communication framework to exchange the type of data you are looking for?
For example, are you exchanging secured email with a HIE or other provider? You can start with the Direct Project. If your HIE is mandating that you exchange data via XCA (Cross Community Access), you can start to examine the standards at the IHE XCA profile page. If they need bi-directional document sharing and are requiring you to follow the XDS standard, you can examine that standard at the IHE XDS profile page.
Hopefully these starting steps will get you on your way to integrating your EHR with many different organizations in order to further help the electronic sharing of data in the medical industry.