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Depending on the technical infrastructure an HIE adopts, a number of different services may be offered centrally. These components are referred to as “shared services,” and often include:
Master Patient (or Person) Index
The master patient index is a database containing a unique identifier for all patients under the domain of an HIE. Hospitals, health systems, labs and other entities may have localized identifiers for patients, meaning that multiple numeric codes across the continuum of care can refer to one patient. When a provider queries the HIE for a patient’s information, the MPI uses the patient’s demographic information to match all appropriate records in the numerous disparate systems across the HIE spectrum.
The Master Patient Index uses several matching algorithms to find all of a given patient’s records across disparate systems and match these records to the correct patient. These algorithms typically match based on the patient’s name, date of birth, mailing address, telephone number, and a combination of additional data elements, such as insurance or family information that ensure accuracy. The more data elements incorporated into the matching process, the more accurate the process becomes. Still, human intervention in the matching process is sometimes necessary to ensure the accuracy of the records being associated with an individual.
HIEs need to consider their policies for patient matching and their tolerance for creating duplicate patients when the matching algorithm cannot make a definite patient match. As such, the user may see two patients that may be the same person. A process must be developed to support the manual matching of these patients to maximize the value of the system and minimize the user’s effort in locating needed patient information.
Record Locator Service
Once the MPI matching system has identified records across the many stakeholders in the HIE and designated the individual with a unique identifier, the record locator service (RLS) directs the HIE user to the physical storage locations of all relevant data. The record locator service contains no actual health data, only information on the whereabouts of where the desired data resides in the realm of the HIE. Data may be located on edge servers, at provider sites, in a central location, at a public health agency, or in any other number of places, and the RLS directs users to the correct stakeholder for retrieval.
No actual exchange of information takes place through the RLS. The Master Patient Index and Record Locator Service work in concert to direct the provider or entity querying the HIE to all of the relevant health information, without storing or sending any of the actual data.
Trust Broker
The trust broker is a list of all participating stakeholders in the HIE, and the specific provisions each stakeholder has approved for the exchange of health information. This may include the permissions each stakeholder organization requires for the exchange of data, the organization-specific patient consent models, and other critical aspects of exchange between one stakeholder and another.
Provider Directories
The provider directory is a comprehensive list of all licensed clinicians in a given state. As providers push or pull health data through the HIE and query for specific data, it is important to verify the credentials of each associated stakeholder or provider. Authentication of providers is a cornerstone security functionality of health information exchange.
The following entities have been recommended by the HIT Policy Committee’s Information Exchange Work Group for listing in an entity-level (organizations) provider directory:
- Health care provider organizations (i.e., hospitals, clinics, nursing homes, pharmacies, labs)
- Other health care organizations (i.e., health plans, public health agencies)
- Health Information Organizations (i.e., regional HIE operators, health information service providers)
- Other organizations involved in the exchange of health information (i.e., business associates, clearinghouses)
The following entities have been recommended by the HIT Policy Committee’s Information Exchange Work Group for listing in an individual-level (providers) provider directory:
- Provider name and credentials
- Locations for each provider (addresses)
- Phone number
- Email address
- Hospital affiliation
The following resources may provide helpful guidance for provider directories:
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