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Development of Florida’s Health Information Exchange (HIE) Initiative

Within the past decade, there have been tremendous novelty technological advancements that have been aimed at improving the quality of health care being provided to the American population. One such innovation is the Health Information Exchange (HIE). HIE is a technological initiative towards ensuring electronic conveyance of healthcare information among healthcare providers (Hussain, 2015). Florida’s HIE has been in operation since 2011. Although numerous challenges have been faced from that time, Florida’s HIE continues to forge ahead. The purpose of this paper is to review Florida’s HIE with respect to various fronts and in comparison with the HIE of Ohio, North Carolina, and Illinois.

Health care institutions in Florida have taken steps to invest in HIE technology. The services are provided through Florida’s Agency for Health Care Administration (AHCA) (Landi, 2016). AHCA offers three main services to health care providers which enables them to share information and the services include; Patient Look-Up (PLU), Direct Messaging, and Event Notification Service (ENS) (Landi, 2016). Florida also takes part in an eHealth exchange program for interstate health information exchange (Landi, 2016).

The ENS is an automated alerting service that gives real-time alert notifications to the various health care providers wherever a patient has been discharged from an emergency department or a hospital to other health plans or other Accountable Care Organizations (ACO) (Landi, 2016). Notifications are also provided whenever an alarm event occurs. The real-time notifications are sent to all health care facilities that have subscribed to the service. This service was officially commenced in 2013. It ensures coordination of care among healthcare providers in Florida since information and notifications are expeditiously sent in real time. Florida is ahead of the state of Illinois in this respect since the latter is still in the initial phase of the development of the HIE infrastructure and has not yet commenced the use of the ENS system (Kho, 2014). As a result of the state’s inability to share data through this system, it is arguable that coordination is hampered. This system has also not yet been adopted in North Carolina and Ohio. The ENS system sets Florida’s HIE apart from the three states and it fosters coordination of care among health care providers within the state.

The implementation of HIE in Florida also supports evidence-based research because of the convenient compilation of information through the Direct Messaging Service (DMS). DMS ensures that health care providers send and receive messages and attachments in a secure way (Office of the National Coordinator for Health Information Technology, 2013). AHCA ensures that a secure webmail is provided “for physicians and other providers to send or access medical records sent by other providers” (Office of the National Coordinator for Health Information Technology, 2013, p. 2). Protected health information remains encrypted.  As a result of the compilation of real-time information regarding the progress of patients, evidence-based research is supported since the information can, in turn, be used to inform new studies, answer questions, and make scientific discoveries (Landi, 2016). A direct and secure messaging system has also been utilized in the state of Illinois. Therein, health care providers are required to sign up for the ILHIE direct messaging system so as to contain email messages containing patient data (Kho, 2014). The system has also been utilized in Ohio and in North Carolina. Through North Carolina’s NC HealthConnex, for instance, various health providers get access to patient records through the messaging system (Snipes, 2017). Direct messaging assists in the building of a body of real-time information that can be used in the development of evidence-based research.

One of the major public health initiatives that have been clamored for and sought after by the federal government is the use of health information technology to improve treatment outcomes, reduce the cost of health care, and foster progressive collaboration between health care providers. In line with this initiative, the American Recovery and Reinvestment Act of 2009 (ARRA) and therein, the public health initiative of health information technology has been made a priority and to that effect, about $47 billion has been allocated by the federal government (Shaw, 2009). The Act stipulates that $21.6 billion in Medicaid funding has specifically ben set aside to ensure that hospitals, medical professionals, and other health care providers have adopted and meaningfully used Electronic Health Records (EHR) (Shaw, 2009). Consequently, public health initiative and the elaborate provisions of the ARRA, states have received grants from the federal government for the purpose of establishing technological infrastructure with respect to the health information exchange. This means that the HIE initiatives of Florida have served to bolster the fulfillment of the aforementioned public health initiative.

The participation rate of health care providers in the health information exchange initiatives has been steadily rising. For instance in Florida, the Patient Look-Up (PLU) service enables the patient-centered exchange of clinical information between the subscribed health care provider-participants of the service (Landi, 2016). By the end of 2016, there were 15,000 PLU-covered hospital beds, which are 23% of the state’s hospital beds (Landi, 2016). It is also important to note that over 500,000 queries are recorded in the PLU service and there are over 23,000 matched patient records (Landi, 2016). It is essentially apparent that the participation rate is steadily rising in Florida. The same is seen in Illinois and Ohio. In Illinois, for instance, the ILHIE service is offered free-of-charge and is available to all health care providers who have signed up to the service (Kho, 2014). As a result of this availability, many institutions have signed up for the service. In North Carolina, however, the participation rate is still low. This is mainly because of the approaches taken by the state government therein. As of 2017, only three large health care systems in the state had signed up to share information through the NC HealthConnex (Snipes, 2017). The participation rate of providers is highly reliant on the approach taken by the state.

Conclusively, the HIE is aimed at ensuring electronic conveyance of health care information among health care providers. Florida’s HIE has been in operation since 2011. Through the AHCA, Florida offers three main services to health care providers for the purpose of sharing data and they include; Patient Look-Up (PLU), Direct Messaging, and Event Notification Service (ENS) (Landi, 2016). With regard to the ENS system, Florida is ahead of North Carolina, Illinois, and Ohio since the three states have not commenced the use of a similar infrastructure. All four states have, however, taken considerable steps towards the implementation of the federal HIE initiative.