Case Study: State Level Governance of Health Information Exchange - Data Governance: Creating Value from Information Assets - page 180

and physicians' offices, and connect them to HIE networks to access
patient records from other healthcare participants. Federally funded
state-designated entities have been created to govern and promote health
information exchange and work with the federally funded regional exten-
sion centers authorized to help implement EHRs in physicians' offices.
Often these are the same organization.
Patient Lookup Model of Health Information Exchange
The HIE is based on a communication network model that facilitates the
movement of electronic data among nodes on the network. What is gener-
ally considered the health information exchange model can be referred to
as the patient lookup model. When a clinician enters a patient's identifying
information into the HIE portal, it connects to a medical record repository
and uses database software to search out all available electronic medical
records from the data sources on the network (Just and Durkin, 2008).
The records thus aggregated are then displayed on the computer screen
for a physician to select. Because the records form a longitudinal record
on the patient from disparate sources, a physician can obtain a broader
view of the patient's medical history than might be available from paper
records. Records can include demographics, discharge notes, continuity of
care records, problem lists, medications, lab results, encounter histories,
and so on. The availability of records is dependent on the number and type
of participants who join the HIE as data sources and on the data sharing
rules embedded in HIE participation agreements (Kolkman, 2011; HIE
Guide Work Group, 2009).
A representative use case of the patient lookup model can be seen in the
emergency room where a patient comes in without records. The ability to
send a record request to the community HIE allows the emergency room
physician to find vital information on the patient, potentially reducing
duplicate tests and providing more informed care and treatment. This use
case is shown in Figure 8.1 , in which an emergency room physician can
draw on data resources in the hospital and from the community HIE.
The technical infrastructure of the HIE is more complicated than the
simple description of the patient lookup model. There are both hardware
and software requirements that allow a physician to submit a request for
a patient's records, accurately identify that patient, and match him/her to
a correct set of medical records within several seconds before delivering
a listing of them. A typical HIE query starts from an online portal that