HIE Survey

2018 HIE Survey.doc

National Survey of Health Information Exchange Organizations (HIO)

HIE Survey

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2018 Health Information Organization (HIO) Survey


The nationwide survey of HIOs is being led by Dr. Julia Adler-Milstein at the University of California, San Francisco and is sponsored by the Office of the National Coordinator for Health IT (ONC). Over the past eight years our research team has conducted five nationwide surveys of organizations working to promote Health Information Exchange (HIE) to determine the state of current efforts, scope of activities, and financing. Our most recent findings were published in the March 2016 issue of Health Affairs and offered an independent, comprehensive evaluation of HIE progress.


As you know, the field continues to change rapidly, and this survey will enable us to focus on new achievements and identify challenges to create a current and accurate picture of HIE efforts.

We request a brief amount of your time to complete our survey. Participation is completely voluntary and will contribute to a research study. We realize that you receive many such requests and thank you in advance for your time.


The survey includes questions in three broad areas:


  1. Organizational Demographics

  2. Information Blocking

  3. Implementation/Use of Standards


We will not make ANY responses to questions publicly available or attribute responses to any specific organization. These data will only be presented in aggregate and will be published in a peer-reviewed journal (which we will be happy to send to you) and other publicly available publications and presentations. We will create a de-identified dataset to share with ONC.


To thank you for your time, upon completion of the survey you will be offered a $50 amazon.com gift certificate. If you are not eligible for our survey, you will be offered a $10 amazon.com gift certificate.


If you have any questions, please contact the project investigator, Dr. Julia Adler-Milstein (Julia.Adler-Milstein@ucsf.edu or 415-476-9562).


If you are involved with multiple efforts, please let us know so that we can send you another link to the survey. This will ensure that you fill out only one response per effort. We also ask that you respond to survey questions only from the perspective of your organization. Please do not attempt to summarize multiple efforts that may be affiliated with your organization (For example, if you are a state-level HIO, please do not respond on behalf of local HIOs with whom you work.)










We would first like to ask you about the type of organization for which you are responding:


Screening Questions


1. As of January 1, 2019 was your organization (select one):


Building (or planning for) the infrastructure or services to support*, or pilot testing, electronic health information exchange across your network (End of survey)

Supporting* “live” electronic health information exchange across your network

No longer pursuing or supporting* electronic health information exchange (End of survey.)

Never pursued or supported* electronic health information exchange (End of survey.)


2. Does electronic health information exchange take place between independent entities (i.e., between or among those that are not affiliated with one another)**?


Yes

No (End of survey)



* Supporting is defined as offering a technical infrastructure that enables electronic health information exchange to take place.


**Independent entities are defined as institutions with no financial relationship or shared, central governance; HIE between independent entities requires that at least one entity is independent of the other(s).











From this point forward, required questions are marked with an asterisk.


Organizational Demographics


1. Please indicate if your organization is (select all that apply):


State HIE or State-designated Entity (SDE)

Regional or Local HIE

Private, Enterprise HIE

Network-of-Networks (i.e., facilitating exchange between networks)

Public Health Department or Public Health Agency

State Medicaid agency

State Government (other than state Medicaid or Public Health)

Healthcare Delivery Organization (e.g., hospital, IDN, IPA, ambulatory practice)

Health Information Service Provider (HISP)

Technology Vendor (End of survey if only this option is selected)

Other (please list):     


2. *Please report whether each type of stakeholder is involved in your HIE in the following ways:


Answer Options

Provides Data

Views or Receives Data

Pays to Participate in HIE

INPATIENT SETTINGS




Veterans Affairs (VA) Hospital

Publicly-Owned Hospital (e.g., state, county)

Private Medical/Surgical Acute Care Hospital

Private Psychiatric, Rehabilitation, or Long-Term Acute Care Hospital

Long-Term Care Provider

(e.g., nursing home, skilled nursing facility)

AMBULATORY SETTINGS




Community Health Center or Federally Qualified Health Center

Independent Physician Practice or Practice Groups (e.g., IPAs)

Hospital-Owned or Health System-Owned Physician Practice

Behavioral Health Provider (e.g., community mental health, SUD/OUD)

OTHER SETTINGS




Independent Laboratory

Independent Radiology/Imaging Center

Pharmacy

Public Health Department

Emergency Medical Service

Private Payer (e.g., Blue Cross)

Public Payer (e.g., Medicare, Medicaid)

Federal Agency (e.g., SSA, VA/DOD)

Social Service Agency (e.g., housing, transportation, food, financial services)

FEMA or Other Disaster Relief Organization

Other (please specify):     


(If in #2 one or more hospital types selected as providing or receiving data):

3. *Within the past year, please estimate the number of acute care hospitals (individual institutions, not systems; including VA, public, and private) that are directly connected to your HIE and:

Provide data

      Do not know

Receive or view data

      Do not know


4. Please ESTIMATE the number of licensed healthcare professionals with prescribing privileges (e.g., MD, DO, NP) who are:


Eligible to participate (e.g., have an “account”)       Do not know

Participate (i.e., are active users)       Do not know


5. If you have a Master Patient Index (MPI), please ESTIMATE how many patients are in your MPI and, if known, ESTIMATE what percent have at least one CCDA associated with them?


Estimated Number of Patients in MPI

Estimated Percent of Patients in MPI with CCDA(s)

      Do not know

      Do not know


6a. Please ESTIMATE the number of EHR vendors to which you have built interfaces:

      Do not know


6b. Please list the top 5 EHR vendors to which you have built interfaces that represent the largest volume of participants in your HIE:

      Do not know


7. *In which state(s) does your HIE facilitate health information exchange?


All

Alabama Alaska Arizona Arkansas

California Colorado Connecticut Delaware

Distr. of Columbia Florida Georgia Hawaii

Idaho Illinois Indiana Iowa

Kansas Kentucky Louisiana Maine

Maryland Massachusetts Michigan Minnesota

Mississippi Missouri Montana Nebraska

Nevada New Hampshire New Jersey New Mexico

New York North Carolina North Dakota Ohio

Oklahoma Oregon Pennsylvania Puerto Rico

Rhode Island South Carolina South Dakota Tennessee

Texas Utah Vermont Virginia

Washington West Virginia Wisconsin Wyoming


8. *For the state(s) selected in the prior question, please select the specific hospital service area(s) in which your HIE facilitates exchange.

Hospital Service Areas are geographic areas defined by the Dartmouth Atlas.


[Populate list of HSAs for each State reported in prior question and have check all option for HSAs in a given state]      


9. Which of the following services do you offer that are used by participants in your HIE? Select all that apply:

GENERAL SERVICES


Provider Directory

Consent Management

Community Health Record: Aggregation of health information from across the community served by the HIE

Record Locator Service

Messaging using the Direct Protocol

Receive CCDAs

Parse and store data elements from a CCDA

Transform other document types or repositories into CCDAs (e.g., MDS, OASIS, Community Health Record)

Alerting services (e.g., gaps in care) and/or event notification (e.g., Admit-Discharge-Transfer)

Connection to prescription drug monitoring program (PDMP)

Prescription fill status and/or medication fill history

Provide data to third party disease registries (e.g., Wellcentive, Crimson)

Advanced care planning (i.e., POLST/MOLST)

Integrating claims data

Other (please list):      



Services related to VALUE-BASED PAYMENT MODELS


Providing data to allow analysis by networks/providers

Generating quality measures

Validating quality measures

Reporting quality measures to payers/programs on behalf of participants

Operating as a clinical registry including a qualified clinical data registry (QCDR)

Analytics (e.g., risk stratification)

Other (please list):      


10. Does your HIE: (check all that apply)



Sell/provide your infrastructure to other HIEs

Buy/use infrastructure from another HIE

Connect to other HIEs in SAME state

Connect to other HIEs in DIFFERENT state(s)


11. *Is your HIE currently using the following national networks to exchange data?


Operational (i.e., using to exchange data)

CareinAlliance

CommonWell

Digital Bridge

DirectTrust

Surescripts

Strategic Health Information Exchange Collaborative (SHIEC)/Patient Centered Data Home (PCDH)

e-Health Exchange

Carequality

Other (please list):      


12. (If none selected in prior question) Please select reason(s) why your HIE is not operational with any of the national networks listed above? Select all that apply:

Do not see value in what they provide (i.e., services not useful)

Perceive them as competitors

Participation costs too high

Not a priority

Other (please list):      



13. Is your HIE planning to participate in the Trusted Exchange Framework and Common Agreement?


Yes No Don’t know


14. How is your HIE planning to respond to the proposed Trusted Exchange Framework and Common Agreement:


Increase

No change

Decrease


Not Applicable

Types of services offered

Selling/providing your infrastructure to other HIEs

Buying/using infrastructure from another HIE

Partnering with HIEs in SAME region/state

Partnering with HIEs in DIFFERENT regions/states

Other (please list):      


15. How long has your HIE been operational (i.e., from completion of initial pilot to present):


Less than one year

1-2 years

3-5 years

6-10 years

11 or more years


16. Do you receive funding from a state innovation model (SIM) grant?

Yes

No


17. *Do entities participating in your HIE cover 100% of your operating expenses?

Yes

No


17a. (If no) Do you expect to earn sufficient revenue from participating entities to cover 100% of your operating expenses in the future?

Definitely not

Probably not

Maybe

Probably will; how long do you expect that it will take?       Years

Definitely will; how long do you expect that it will take?       Years

Don’t know


18. To what extent does each of the following factors pose a moderate or substantial challenge to your development? Select all that apply:


Answer Options

Moderate or Substantial

Competition from other health information exchange efforts

Competition from health IT system vendors offering HIE solutions (e.g., EPIC’s CareEverywhere)

Stakeholder concerns about their competitive position in the market

Addressing federal government regulations

Addressing state government regulations

Addressing governance issues

Stakeholder concerns about privacy and confidentiality issues (e.g., HIPAA, consent)

Stakeholder concerns about cybersecurity issues (e.g., breaches)

Managing complexity of consent models

Developing a sustainable business model

Addressing technical barriers (e.g., procurement architecture, applications)

Limitations of current interface standards

Lack of resources to implement interface standards

Accurately linking patient data/patient matching

Ability to hire/retain staff

Integration of HIE into provider workflow

Other (please list):      


Information Blocking


Section 3022(a) of the Public Health Service Act (PHSA) defines information blocking as a practice that

  • is likely to interfere with, prevent, or materially discourage access, exchange, or use of electronic health information;

  • is not required by law and is not otherwise reasonable and necessary; and

  • is committed by

    • a health information technology developer, exchange, or network who knows, or should know that the practice is likely to interfere with, prevent, or materially discourage access, exchange, or use of electronic health information; or

    • a health care provider who knows that the practice is unreasonable and likely to interfere with prevent, or materially discourage access, exchange, or use of electronic health information


  1. In what form(s) have you experienced information blocking by EHR vendor(s)?


Never/ Rarely

Sometimes

Often/ Routinely

Don’t Know

PRICE


e.g., using high fees to avoid granting third-parties access to data stored in the vendor’s EHR system


charging unreasonable fees to export data at a provider’s request (such as when switching vendors)

CONTRACT LANGUAGE


e.g., using contract terms, warranty terms, or intellectual property rights to discourage exchange or connectivity with third-party


changing material contract terms related to health information exchange after customer has licensed and installed the vendor’s technology

ARTIFICIAL TECHNICAL, PROCESS, OR RESOURCE BARRIERS


e.g., using artificial technical barriers to to avoid granting third-parties access to data stored in the vendor’s EHR system

REFUSAL


e.g., refusing to exchange information or establish connectivity with certain vendors or HIOs


refusing to export data at a provider’s request (such as when switching vendors)

Other (please list):      



  1. Overall, to what extent have you encountered EHR vendors engaging in information blocking?

What proportion of vendors?

Among vendors that engage in information blocking, how often do they do it?

All

Most

Some

Few

Don’t know or N/A (Don’t interact with EHR vendors)

Often/Routinely

Sometimes

Rarely/Never

Varies by vendor

Don’t know


  1. When information blocking by EHR vendors occurs, does it vary by vendor marketshare?

Yes – predominantly by vendors with large marketshare

Yes – predominantly by vendors with moderate marketshare

Yes – predominantly by vendors with small marketshare

No - does not vary by marketshare

Don’t know


  1. In what form(s) have you experienced information blocking by hospitals and health delivery systems?


Never/Rarely

Sometimes

Often/Routinely

Don’t Know

ARTIFICIAL TECHNICAL, PROCESS, OR RESOURCE BARRIERS


e.g., requiring a written authorization when neither state nor federal law requires it


requiring a patient to repeatedly opt in to exchange for TPO

REFUSAL


e.g., refusing to exchange sharing of information with competing providers, hospitals, or health systems

Other (please list):      


  1. To what extent have you encountered hospitals and health delivery systems engaging in information blocking?

What proportion of hospitals and health systems?

Among hospitals and health systems that engage in information blocking, how often do they do it?

All

Most

Some

Few

Don’t know or N/A (Don’t interact with hospitals and health systems)

Often/Routinely

Sometimes

Rarely/Never

Varies by hospital/health system

Don’t know



Implementation and Use of Standards


24. Which of the following technical standard(s) does your organization regularly use to access and/or exchange provider data associated with a provider directory? Select all that apply:


Exchange standards based on IHE IT Infrastructure Technical Framework Supplement, Healthcare Provider Directory (HPD) Trial Implementation

HL7 v2 MFN interface

Exchange standards based on HL7 Fast Healthcare Interoperability Resources (FHIR)

Exchange based on ASC X12 274

Other (please list):      

Don’t know


25a. To what extent does your HIE electronically exchange care summaries among providers in a structured format (e.g., CDA, CCR, C32)?

To a great extent (go to 25b)

To a moderate extent (go to 25b)

To a small extent or not at all (skip to 26)



25b. To what extent do EHR installations you integrate with use the following templates for C-CDA?

C-CDA Template

All or most EHR installations

Some EHR installations

Few or no EHR installations

Don’t know

Continuity of Care Document (CCD)

Discharge Summary

Referral Note

Care Plan

Other C-CDA templates (please list):      


26. Which types of clinical and other health-related information are made available by/through your HIE (as part of a clinical document or as a discrete field)? Select all that apply:

NOTE: CCDA and CCDS (2015) data types included for reference



Included in your HIE

Included in CCDA

Included in CCDS (2015)

Smoking Status

Problems

Medications

Filled Medications


Medication Allergies

Laboratory Test(s)

Laboratory Value(s)/Result(s)

Vital Signs

Care Plan Field(s), including Goals and Instructions


Procedures

Care Team Member(s)

Immunizations

Unique Device Identifier(s) (UDIs) for a Patient’s Implantable Device(s)

Assessment and Plan of Treatment

Goals

Health Concerns

Radiology Result(s)



(Diagnostic Image Reports)


Clinical Notes

(Note Section/Note Activity – C-CDA 2.1 Companion Guide


Discharge Disposition


Substance Use Disorder (as defined in 42 CFR Part 2)



Social Determinants of Health (e.g., housing, food insecurity)



(Veteran’s Status/Military History not included)


Admission and Discharge Dates and Locations


Encounters


Referrals


Discharge Instructions


Family Health History


Functional Status


Cognitiive Status


Gender Identity



Pediatric Vital Signs


Pregnancy Status


Reason for Hospitalization


Provenance


Other (please list):     




27a. Does your HIE engage in delivery of results or other information (“push”) to share data with your participants? Note: delivery of results of other information refers to a one-directional transmission, e.g. through an interface into an EHR or clinical registry.


Yes (go to 27b/c) No (skip to 28) Don’t Know (skip to 28)


27b. Please ESTIMATE your monthly average volume of outgoing transactions (with or without attachments):

      Don’t Know

27c. To what extent do EHR installations you integrate with receive what you send using each of the following standards?


All or most EHR installations

Some EHR installations

Few or no EHR installations

Don’t know

HL7 v2 messages

HL7 CCDA documents

HL7 Fast Healthcare Interoperability Resources (FHIR) messages DSTU2 or later)

Some other open standard managed by HL7 or some other standards development organization

Some other proprietary standard published by the EHR vendor


28a. Does your HIE make data available via participant query to your HIE? Note: query refers to a query-and-response exchange, e.g. a request from one participant through an interface that results in a response delivered into an EHR.


Yes (go to 28b/c/d/e) No (skip to 29) Don’t Know (skip to 29)


28b. Please ESTIMATE your monthly average volume of queries placed (regardless of whether data available):


      Don’t Know


28c. Please ESTIMATE the average percent of queries with data returned:


      Don’t Know


28d. To what extent do EHR installations you integrate with use the following standards to query your HIE?


Some or most EHR installations

Few or no EHR installations

Don’t know

IHE XDS (Cross-Enterprise Document Sharing)

IHE MHD (Mobile Access to Health Documents)

IHE XCA (Cross-Community Access)

NwHIN Specifications for Query for Documents and Retrieve Documents

HL7 Fast Healthcare Interoperability Specifications (FHIR) DSTU2 or later for data element query

HL7 Fast Healthcare Interoperability Specifications (FHIR) DSTU2 or later for document query


28e. What type(s) of responses do you return when you receive queries from your participants? Select all that apply:


Existing documents: respond with documents created by other systems such as EHRs and stored or accessible by the HIE

Dynamic documents: respond with a document produced upon demand from a community health record or other repository of clinical data

Other (please list):      

Don’t know

29a. Does your HIE exchange health information with other HIEs or private enterprise networks (e.g. integrated delivery systems) that are NOT part of your HIE (e.g., your HIE queries them or they query your HIE)?


Yes (go to 29b/c/d) No (end of survey) Don’t Know (end of survey)


29b. Which of the following standards do you use to exchange health information with these external entities? Check all that apply



IHE XDS (Cross-Enterprise Document Sharing)

IHE MHD (Mobile Access to Health Documents)

IHE XCA (Cross-Community Access)

NwHIN Specifications for Query for Documents and Retrieve Documents

HL7 Fast Healthcare Interoperability Specifications (FHIR) DSTU2 or later for data element query

HL7 Fast Healthcare Interoperability Specifications (FHIR) DSTU2 or later for document query

Other (please list):      

Don’t know


29c. What type(s) of query do you place to HIEs or private enterprise networks outside your HIE? Select all that apply:

Directed to one entity: a query to a single system known or believed to be the source of the information

Directed to many entities: a single query to multiple, named systems that may have information that is returned as multiple documents or single, consolidated document

Broadcast: a query to all or a geographic subset of systems where the source of information is unknown, returning multiple documents or single, consolidated document

Other (please list):      

Don’t know

NA—do not place queries


29d. What type(s) of responses do you return when you receive external queries from HIEs or private enterprise networks outside your HIE? Select all that apply:


Existing documents: respond with documents created by other systems such as EHRs and stored or accessible by the HIE

Dynamic documents: respond with a document produced upon demand from a community health record or other repository of clinical data

Other (please list):      

NA—do not return queries

Don’t know

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