To move forward, HIEs need to be sustainable and innovative, proving their value to participants. Enhancing their service offerings is part of this effort. In the following section, five different service offerings are detailed: image access, emergency medical services support, personal health records (PHRs), electronic patient consent, analytics, and accountable care organization support.

Image Access
HIEs should consider offering the exchange of full images between providers, hospitals, labs, and radiology centers. One option is to have users download an Image Viewer application that allows them to instantly open images attached to radiology reports. Radiologists can view images on the HIE to compare prior studies, emergency room physicians can also view recent images, and specialists can access diagnostic quality images without patients needing to provide CDs or copies.

Emergency Medical Services (EMS) Support
An HIE can work with regional emergency medical services to support the flow of critical patient information from the ambulance to the emergency room, and from the ambulance to the HIE. Additionally, EMS providers would be able to access patient information on the HIE. EMS providers would not only see current medications and the problem list for patients onsite, but could also have access to advance directives including MOLST (Medical Orders for Life Sustaining Treatment) information.

Personal Health Record (PHR) Connectivity
HIEs can offer a patient portal that allows patients to set their consent preferences, request an audit of HIE access to their medical information, update their health information, and attach advance directives to the medical information on the HIE. Patients may also have the ability to link their untethered PHR (such as Microsoft HealthVault or Google Health) or a tethered PHR to a Patient Portal in order to download their medical information from the HIE.

Analytics/Reporting
Clinical analytics is one of the most exciting and promising areas for HIE innovation. Analytics are, at their most basic level, data points that are leveraged through analysis to make better informed decisions. Analytics have historically been based exclusively on claims data and have involved an arduous data mining process. With the increasing use of EHRs and HIEs, analytics can begin to shift towards a combination of clinical and claims data. As analytics shifts towards the use of clinical data, claims data will also be very important for filling in gaps in the clinical data. Providers must submit claim data for every encounter; however, as they transition to EHRs, clinical data may not be submitted for every encounter. The combination of clinical and claims data, therefore, can become a powerful tool for providers.

HIEs are well positioned to offer analytic services to their customers. As the trusted data exchange entity for a given region, HIEs can compile data across disparate systems, including data from competitors. Once the data is compiled, complex algorithms can be run against data in a data warehouse or data mart, and can be used for predictive modeling, real-time point of care decision support, and comparative effectiveness research. As HIEs begin to connect with state level, and ultimately nationwide, databases they will be able to offer even better data to providers at the point of care.

HIEs performing analytics will also be able to support providers, hospitals, and payers in their quality reporting measures. These groups must currently perform a laborious data mining process, that is predominantly based on claims data. HIEs can use analytics to ease the quality reporting burden for providers, hospitals, and payers. In addition, the use of clinical data may enhance their quality reporting.

Accountable Care Organizations (ACO) Support
ACOs will put a greater demand on providers’ and hospitals’ needs to access and move health information across disparate systems. They will need access to this data to understand and reduce risk to ensure cost savings. The need for this data will push interoperability between acute care, ambulatory care, and patients. HIEs can be the trusted intermediary between entities. Additionally, as HIEs increase their analytic capabilities, they will be able to manage risk stratification (identification of at risk populations), improve real-time decision support and transitions care. HIEs can develop care management applications that are based on complete patient data. These applications will support providers and hospitals in managing risk, increasing quality of care, and decreasing cost.