Pediatric Partners has adopted provider-centered exchange between their practice and Rady Children's Hospital. The integration allows users in both systems to pull the clinical information and provider notes directly into their local EMR. Both the hospital and Pediatric Partners have the ability to query each other’s systems to retrieve CCDAs. Both systems are able to integrate the CCDAs into their internal EHRs supported by different vendors.

HEALTHeLINK, in cooperation with Researchers at the Brookings Institution, conducted a pilot study to examine the impact of the use of health information exchange (HIE) technology on reducing laboratory tests and radiology examinations in emergency departments (EDs) at three area hospitals. The results of the pilot show a significant reduction in the duplication of tests.

The Erie County Health Department partnered with HealtheLink in 2011 to access the HealtheLink repository of patient data in order to obtain demographic and treatment information for patients with positive lab results. The New York State Health Department provides reports to local health departments on positive lab results that require public health follow-up. Erie County Health Department uses the HealtheLink master patient index (MPI) to locate cases and clinical information to verify patient treatment. HealtheLink provides primary and alternate contacts along with alternate phone numbers from their MPI. Using the HealtheLink virtual health record, Erie County Health Department can confirm the disease diagnosis, review pending labs and lab results, view radiology results, and evaluate a full clinical picture of a patient’s course of illness. In the first six months of 2015, the Erie County Health Department made 20,000 queries to the HealtheLink virtual patient record.

The Kentucky Health Information Exchange (KHIE) is the public health authority for Meaningful Use in the state of Kentucky, as deferred from the KY Department for Public Health. Providers are required to connect with KHIE in some capacity, in order to attest to the EHR Incentive Program. Serving in this function has allowed KHIE to broaden its interoperability efforts and capture a range of data used for public health reporting. Between 2011 and 2012, KHIE implemented support for public health data submissions for: immunization data for the KY immunization registry

Nebraska Health Information Initiative (NeHII) and the Nebraska Department of Health and Human Services (NE DHHS) successfully launched a Public Health Gateway (PHG) pilot project to automatically share syndromic surveillance data. The pilot implementation demonstrated successful integration and automation between a critical access hospital’s electronic health record system, NeHII, and the state’s Syndromic Surveillance Detection of Nebraska (SSEDON) data collection process. The hospital’s ADT feed to NeHII was enhanced and route to the PHG Syndromic Surveillance interface, which provides data mapping, transformation, and sequencing to meet state syndromic surveillance implementation guide specifications. The Many-to-one gateway model provides an efficient alternative to development of point-to-point interfaces between healthcare facilities and the state. Planning is underway to expand this service to additional NeHII participating organizations.

Great Lakes Health Connect (GLHC) found that Meaningful Use has driven the implementation of electronic submissions of immunization, reportable lab, and syndromic surveillance messages to state registries. Scaling the implementation from hundreds to thousands of locations in a short period posed a significant challenge. Building unique interfaces for each EHR was not a scalable approach. GLHC implemented a single gateway for each state registry and developed a standard interface process through their HIE vendor. Instead of establishing a costly VPN, GLHC used a software agent from their vendor that uses the public internet to transact encrypted messages to GLHC’s core platform. This made the requirement for even the smallest office to have just a simple internet connection. GLHC was able to install the agent in a few minutes and have each office ready to go. Overall, this architecture allowed GLHC to on-board many offices each week and quickly respond to the needs across the state.

Quality Health Network (QHN) of Grand Junction Colorado receives real time HL7 ADT messages for urgent care, emergency department, and inpatient stays. Providers are offered the option of receiving the messages for all of their patients or can subscribe to a specific group of patients, e.g., diabetics to support population health management. QHN supports multiple methods for notification delivery, e.g., Direct messaging, secure file transfer, or forwarding the ADT messages. This enables QHN to support variations in provider workflow. In the second quarter of 2015 QHN provided over 23,000 alerts to 38 participating practices.

Great Lakes Health Connect (GLHC) has many sources of inbound HL7 ADT data from its participating hospitals. It also has the ability to route those messages to community providers based on the information contained within the ADT messages. However, most community providers do not know what to do with an HL7 message, as they are either unable or unwilling to integrate those messages into their EMR or do not have an EMR system. In order to meet the needs of these providers, GLHC uses its interface engine to create a .pdf formatted notification report pulling out the data from the raw HL7 message. Once completed, GLHC reformats the inbound HL7 ADT message to instead look like a standard HL7 Result message and attach the newly created report to it. GLHC uses their standard result delivery process to send those notifications to a GLHC inbox deployed within the office. Providers not otherwise able to get notifications can see -- in near real time -- patient who have been admitted and/or discharged from inpatient, urgent care, and emergency settings. This improves their opportunity for additional reimbursement and enhances the speed with which patients are scheduled into the office to ensure compliance with discharge instructions, resulting in reduced readmissions.

The Utah Health Information Network (UHIN) receives ADT messages for emergency room visits and hospital admissions and discharges statewide. Payers and providers can subscribe to these messages for their members and patients. Alerts are sent in real-time using Direct messaging or secure file transfer. Payers and providers can specify the patient cohorts for which they would like to receive alerts. Obstetricians are using the alerts to monitor discharges for maternity patients to support timely postpartum care. A payer uses alerts on ED visits by asthma patients to contact the patient to ensure that they have medication for the routine treatment of their chronic condition. Behavioral health providers receive alerts on hospital admissions for their high-risk patients to enable them to arrange care while the patient is in the hospital. UHIN sends over 12,000 alerts each month.

The Nebraska Health Information Exchange (NeHII) receives notifications of patient hospital admissions and discharges using HL7 ADT messages. These messages are used to generate notification to support PCPs, hospitals, and care givers from home health agencies. NeHII provides the Visiting Nurse Association (VNA) of Omaha with daily alerts of hospital admissions and discharges for their patients. VNA receives approximately 400 notifications per week for patients enrolled in their services. This service has increased the efficiency of intake processing, reduced time spent by VNA calling hospitals, and enabled more timely follow-up with patients.