Learning from Health Information Exchange Technical Architecture and Implementation in Seven Beacon Communities
Background: As health care providers adopt and make “meaningful use” of health information technology (health IT), communities and delivery systems must set up the infrastructure to facilitate health information exchange (HIE) between providers and numerous other stakeholders who have a role in supporting health and care. By facilitating better communication and coordination between providers, HIE has the potential to reduce unnecessary use of services, and improve clinical decision-making, continuity of care, population health management, patient engagement, and continuous learning and improvement.
Challenge: The rapid rate of health IT adoption and evolution, as well as the proliferation of health IT vendors and systems, contribute to a wide range of potential architectures and infrastructure to support HIE. However, the factors that should inform a community’s decision to adopt a particular technical architecture model, as well as the influence of the particular HIE model on the ability to achieve specific health care quality and population health improvement goals, are not well known.
Impact: Based on the diverse experiences of seven communities that participated in the three-year federal Beacon Community Cooperative Agreement Program, this paper offers practical insight into factors influencing the technical architecture of health information exchange infrastructure and its role in supporting improved care, reduced cost, and a healthier population. The case studies also document challenges faced by the communities, such as significant time and resources required to harmonize variations in the interpretation of data standards. Findings indicate that their progress developing community-based HIE strategies, while driven by local needs and objectives, is also influenced by broader legal, policy, and market conditions.
Legal and regulatory concerns, Data network architecture, Data sharing approaches and considerations, Competitive marketplace, Stakeholder engagement and participation
Type of Governance Resource
Other Type of Governance Resource
Healthcare Setting(s) in which Data were Collected
Academic medical center(s), Community health center(s), Community organization(s) (e.g. faith-based organization, etc.), Emergency department(s), Inpatient facility(ies), Long-term care facility(ies), Primary care or ambulatory clinic(s), Specialty clinic(s)
Electronic Health/Medical Records (EHR or EMR), Diagnostic data, Pharmacy databases, Claims, Patient Registries, Health Information Exchanges, Patient-Reported Outcomes, Personal Health Records
Generalizability to Other Settings
The Beacon Communities profiled in this case study vary widely in geographic location, population size and demographics, stakeholder involvement, HIE maturity, legal and market setting, and other factors that contributed to their decisions to adopt a particular HIE technical architecture model. The factors that were common to all the communities may be broadly generalizable to others seeking to establish HIE infrastructure, such as the role of trust and cooperation. The community descriptions may help others identify which setting was most similar to their own in order to evaluate which community-specific factors to consider when choosing a technical architecture model. By comparing their community with those profiled here, others may avoid or minimize some of the challenges encountered by the Beacon Communities and adopt an HIE infrastructure that enables them to achieve their specific quality improvement, cost, and population health goals.
This paper describes the experiences of seven Beacon communities which varied widely in HIE population size, demographics, setting, participating stakeholders, and other factors. These characteristics are described in Table 1 which may help readers determine which community is most similar to their own and how to apply the lessons learned accordingly.
Geographic scope type
McCarthy, Douglas B.; Propp, Karen; Cohen, Alexander; Sabharwal, Raj; Schachter, Abigail A.; and Rein, Alison L., "Learning from Health Information Exchange Technical Architecture and Implementation in Seven Beacon Communities" (2014). Governance Toolkit. Paper 7.
Acknowledgement of Funders
This case study was developed under grants from The Commonwealth Fund to AcademyHealth in support of the Beacon Evidence and Innovation Network and to the Institute for Healthcare Improvement in support of case studies on regional health care improvement.
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.