Shifting from volume- to value-based care requires that patients and providers have access to the most reliable health information available. Given that many patients receive care from multiple providers who are often located at different care centers, physicians may be challenged at times to have a clear picture of where and from whom their patients are receiving healthcare. Consequently, confining health information exchanges (HIEs) to specific and limited regions within a state does not provide a complete healthcare picture, thus reducing the potential efficacy and utility of the HIE system as a whole.

In real-world settings, patients often decide (or need) to travel outside of their county of residence to receive effective and/or essential care because of the geographic distribution of certain providers. For example, a recent study found that of the 3,143 counties in the United States, 49% have not one OB/GYN , largely because they lack a hospital with maternity services.

The use of geographic boundaries within an HIE may unnecessarily create an incomplete healthcare profile for patients. Moreover, limiting the electronic exchange of data based on geography can present a serious dilemma for healthcare providers located near the borders of these areas, as well as group practices and health systems with multiple locations that may not be contained within a geographically constrained HIE.

New York State, for example, has enabled collaboration and coordination of patient care by creating the Statewide Health Information Network for New York (SHIN-NY) to facilitate the electronic exchange of clinical information and connect healthcare professionals statewide. The SHIN-NY enables collaboration and coordination of care to improve patient outcomes, reduce unnecessary or duplicative tests and procedures, and lower costs. There is no reason to believe such HIEs couldn’t operate in other states.

There are eight regional networks in New York State that are considered qualified entities and are connected to each other through the SHIN-NY. While HIEs historically operate their networks in agreed-upon geographic areas, Hixny is a non-profit HIE that recognizes that patients and healthcare providers are not bound by county borders.  The organization provides access to 100% of hospital data in New York State to provide key stakeholders throughout the state with access to real-time health information that can guide clinical decision-making, empower patients to take charge of their health and provide critical insights into healthcare utilization and trends across and within regions and counties.

When making decisions on patient care, physicians need the most comprehensive healthcare information available, which requires access to real-time and accurate patient information not limited to a specific office or geographical border. A patient-centric approach to HIEs that allows data to move across borders as freely as patients themselves is critical for improving the delivery and cost of care at both the provider and state level.

References

Rayburn, F.The Obstetrician-Gynecologist Workforce in the United States. (April 2017). Retrieved from https://www.acog.org/Clinical-Guidance-and-Publications/The-Ob-Gyn-Workforce/The-Obstetrician-Gynecologist-Workforce-in-the-United-States. 2017.