Implementation of Information Exchanges in the State of South Carolina

Question

Investigate HIE efforts in South Carolina: What efforts are being made in the state of South Carolina on implementing an HIE?  Who is leading the initiative in South Carolina? Who are all the parties involved?  Is it a consolidated or federated model?  Do personal health records play a role?

Answer

Health Information Exchange (HIE)is the process and systems that facilitate the mobilization and integration of health care information through the electronic pathways across organizations within a hospital network, a community or an integrated region. Ideally, this concept allows for the movement of clinical data among different health information systems. This includes streamlining the entry and retrieval while emphasizing procedures of speed, security, and privacy of the information. The synchronization of these units further facilitates the analysis of health records and health care patterns by health authorities. Ultimately, this process continues to contribute to the enhancement of health care, the quality, and affordability of health provision amidst the process of health reform. South Carolina Health Information Exchange (SCHIEx) is the HIE system in South Carolina that provides information required in health planning and decision making (SCHIEx Resources, 2017). SCHIEx has well-outlined efforts, implementation systems, and stakeholders that support the operation of the system in accordance to the needs of South Carolina and National Health Care (SCHIEx Resources, 2017).

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South Carolina Health Information Partners (SC-HIP) is a non-profit organization was set up to facilitate transfer and utilization of health information through secure pathways. Additionally, the organization provides this information for utilization by health professionals, hospitals, public health stakeholders and other health entities within South Carolina. The current board members include: Vicki Young, the Chief Operating Officer of the South Carolina Primary Health Care Association, Greg Barabell; Medical Director, Yvonne Rodgers and the Secretary and Shari Donley as the Treasurer (SCHIEx Resources, 2017). Other Board Members include Elizabeth Burt, Vicky Ducworth, Kathy Schwarting and Helga Rippen (SCHIEx Resources, 2017). These board members hold interdisciplinary positions with the Interim Governance Committee and various institutions of public health and health administration.

SCHIEx has utilized numerous implementation resources and practices to ensure that the system is fully integrated into all health components of South Carolina. The system has majorly engaged the public or healthcare consumers on the concepts of EHRs and HIES. In particular, the organization has engaged the public in understanding the system, its importance, the extent of privacy especially during transmission, emergencies, and the interaction with other health care providers. The group has emphasized to the public that sharing of information is carried out as directed by the law and solely for treatment necessities (Berg, 2004).

The implementation process has been reinforced by high levels of interoperability that protect the patients, health givers and health institution while each entity performs its objectives (Berg, 2004). SCHIEx is thus built on open technology that allows different health institutions to select from the different technologies certified under their legislations. The organization is committed to security and patient privacy through the PKI certificate encryption system that protects external or internal tampering and authenticates the transmission of data (SCHIEx Resources, 2017). Notably, the system is skillfully decentralized through a federated information structure that then requires clear authentication and consultation during transmission across different health facilities (Hosek and Straus, 2013).

SCHIEx is modeled after the MarkleFoundation’sConnecting for Health Framework (SCHIEx Resources, 2013). It is then built on a commercial off-the-shelf software technology that implements federated and service oriented architecture. By extension, the model operates as a system of networks, and has been operating within the framework of HIPAA and HITECH. The SCHIEx data flow is divided into three steps that have high focus on multidimensional interoperability. The first step is to provide Patient Information by sending a Patient Identity Feed transaction that updates this information within the domain. This information is then cross-referenced to synchronize any additional information previously entered into the domain. The second step is the addition of documents during which Set-b transactions are converted into the XDS Repository. The third step is the Retrieve of documents at which point the participant sends a PIX Query transaction, queries the SCHIEx XDS registry and queries the appropriate repositories (SCHIEx Resources, 2017). The sequential operation of the system has been a huge contributor to the implementation and execution process in a manner that has been simple and transparent especially for the parties in direct interaction with the systems (Carter, 2007).

The South Carolina SCHIEx utilizes a privacy officer and a site administrator as part of their best practices of implementation.  The Privacy Officer ensures that the organization remains updated on the federal, privacy and interoperability laws. This includes the design of internal policies, their departmental implementation and investigation or modification of other policies. Any identified breaches are highlighted and submitted through an electronic Breach Notification Form within twenty hours as required by procedure (SCHIEx Resources, 2017). The Site Administrator is also a core principal in the implementation process through functions of stuff training, user Agreements, assigning and monitoring logins and passwords. The streamlined collaboration between the Privacy Officer and the Site Administrator has strengthened the operation of the system and increased the transparency and subsequent accountability. As such, the system has gained trust amongst different health stakeholders in South Carolina and thus expanded its capacity in the region.

Even with the great steps being made in the field of electronic health records, there is still a gap in creating a single and independent systemin South Carolina (Kluge, 2001). Thus, health record systems are still being used in collaboration between different systems in a bid to create a single system that is ultimately sustainable in all the different parts of the country (Rees, 2003). Participants of the SCHIEx may thus use the system for mandatory reporting or in connecting with the eHealthExchange. The system provides an online platform, SCHIExClincal Viewer as a space to connect health providers including those without EHRs to view patient information and resources. Notably, in 2014, SCHIEx announced its partnership with Georgia Health Information Network to create the first state-to-state health-information exchange system (SCHIEx Resources, 2017).

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The Governing Authority of SCHIExhas set up a policy manual to establish a comprehensive framework that supports progressive development of HIE policies and standards while meeting other statutory and federal regulations. The Policy Manual is made up of the Policies and Procedures, Compliant or Breach Notification Form, Sample User Agreement and the Interoperability Services Guide Draft. In addition, the legal agreements are the Participation Agreement and the Business Associate Agreement (SCHIEx Resources, 2017).

The Manual Policy and its provisions in combination with the operational systems have supported the Federated model of this HIE. Ideally, this model is fundamentally a collection of clinical repositories remotely controlled and operated. This model is considered more secure and less interoperable in comparison to the centralized model (Hosek and Starus, 2013). Since it does not allow a direct and simplified exchange of information between EHR systems and health facilities, the model is able to track the movement of information. SCHIEx detailed plan if its structuring has boosted the implementation of the system within South Carolina and facilitated even greater research on HIEs and EHRs.

References

Berg, M. (2004). Health Information Management: Integrating Information and Communication. London: Routledge.

Carter, S. (2007). Rise and Shine: Sunlight, Technology and Health. New York: Peter Lang.

Hosek, S. andStraus, S. (2013). Patient Privacy, Consent and Identity Management in Health Information Exchange: Issues for the Military Health System. Santa Monica: Rand.

Kluge, E. (2001). The Ethics of Electronic Patient Records. New York: Peter Lang.

Rees, A. (2003). Consumer Health Information Source Book. Westport: Greeenwood Press.

SCHIEx Resources. (2017). SCHIEx Resources.Retrieved from SCHIEx: www.schiex.org/resources.php