As the preceding modules have demonstrated, HIEs operate in a dynamic and challenging environment. HIEs must move from operational to sustainable to innovative in their efforts to survive. This module addresses how HIEs move forward. HIEs should always have an eye towards the future. They should continually track their progress, ensure forward movement, and consistently improve. There are two main categories in which HIEs can track their progress: activity and outcomes.

Tracking Activity

All HIEs, even those in their early stages, have the ability to track various activity, so stakeholders can understand, manage, improve, and document the clinical and organizational value of their HIE. As an HIE develops, these metrics become important for measuring their developmental success. Activity metrics provide an important baseline as HIEs move from the pilot phase to an operational and sustainable phase. The following activity metrics should be captured by the HIE on an ongoing basis.

• Adoption
  • Entities
  • Physicians
  • Non-physicians
  • Patient records
• Utilization
  • Number of logons per day
  • Number of unique logons per day
  • Number of patient records accessed per day
  • How users are accessing applications
  • Application responsiveness
  • Usage trending
• Consent
  • Volume and status of consents
  • Who recorded consent
• Volume
  • ePrescriptions
    • Transactions related to exchange of eligibility details
    • Transactions on formulary and benefits information
    • Transactions related to medication history
    • Transactions on fill status notifications
  • Immunizations
    • Transactions on query for immunization history and delivery (request and/or receive)
    • Transactions supporting decision forecasting (decision support)
  • Labs
    • Transactions related to ordering of laboratory tests
    • Transactions related to delivery of laboratory tests
  • Surveillance data
    • Transmission of electronic syndromic surveillance data to public health agencies
    • Transmission of electronic data on reportable disease conditions to public health agencies
  • Quality Reporting
    • Transmissions related to reporting of clinical quality measures to CMS or States (Stage 1 MU)
    • Transactions supporting ambulatory clinical quality measures
    • Transactions supporting hospital clinical quality measures
    • Reporting related to additional quality of care metrics
  • Radiology
    • Transmission of radiology results (reports)
    • Transmission of radiology images
  • Registry reporting
  • Eligibility verification transactions
  • Claims transactions
  • Records
    • Transmission of summary of care record from one setting of care or provider to another provider of care
    • Transactions that support the exchange of key clinical information among providers of care and patient authorized entities electronically
  • Prior-authorization transactions

Tracking Outcomes and Using Analytics

As HIEs develop and expand their capabilities, they can begin tracking more than just their activities. HIEs should start tracking outcomes based on usage of the HIE. Tracking outcomes allows HIEs to demonstrate return on investment (ROI), value to their stakeholders, and ensure improved patient care and efficiency. Tracking outcomes requires complex analytical capabilities. There are market tools that analyze all available clinical data to identify positive or negative impacts on the patients and the community, identify potential gaps in patient care, and find patients eligible for registries and care management programs. Consequently, less mature HIEs probably will not be able to track outcomes, but should develop their systems with an eye towards future tracking and reporting outcomes.