title: Learning from health information exchange technical architecture and implementation in seven beacon communities.
abstract: 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 improve clinical decision-making and continuity of care, while reducing unnecessary use of services. When implemented as part of a broader strategy for health care delivery system and payment reform, HIE capability also can enable the use of analytic tools needed for population health management, patient engagement in care, and continuous learning and improvement. The diverse experiences of seven communities that participated in the three-year federal Beacon Community Program offer practical insight into factors influencing the technical architecture of 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.
authors.affiliation: Commonwealth Fund.
authors.forename: Douglas B
authors.initials: DB
authors.lastname: McCarthy
authors.affiliation: Institute for Healthcare Improvement.
authors.forename: Karen
authors.initials: K
authors.lastname: Propp
authors.affiliation: Institute for Healthcare Improvement.
authors.forename: Alexander
authors.initials: A
authors.lastname: Cohen
authors.affiliation: AcademyHealth.
authors.forename: Raj
authors.initials: R
authors.lastname: Sabharwal
authors.affiliation: AcademyHealth.
authors.forename: Abigail A
authors.initials: AA
authors.lastname: Schachter
authors.affiliation: AcademyHealth.
authors.forename: Alison L
authors.initials: AL
authors.lastname: Rein
keywords: Data Reuse; Health Information Technology; Learning Health System; Quality Improvement
references.citation: Am J Public Health. 2009 May;99(5):950-5
references.pmid: 19299671
references.citation: Health Aff (Millwood). 2007 Sep-Oct;26(5):w568-80
references.pmid: 17670775
references.citation: Int J Med Inform. 2012 Dec;81(12):821-7
references.pmid: 23021932
references.citation: Res Brief. 2008 Feb;(2):1-12
references.pmid: 18496926
references.citation: Health Aff (Millwood). 2005 Sep-Oct;24(5):1214-20
references.pmid: 16162565
references.citation: Health Aff (Millwood). 2010 Sep;29(9):1671-7
references.pmid: 20820025
references.citation: AMIA Annu Symp Proc. 2005;:286-90
references.pmid: 16779047
references.citation: Health Aff (Millwood). 2012 Mar;31(3):527-36
references.pmid: 22392663
references.citation: N Engl J Med. 2010 Aug 5;363(6):501-4
references.pmid: 20647183