Is the view only option for HIE worthwhile?

I watched the NeHC University online presentation- an introduction to the HIE Landscape early this month. The results of a survey of active HIEs were presented. Findings were that about half of the responders plan to offer the view only data option while just a quarter plan to support document sharing. In a similar vein, AZ HIMSS offered a state of the state update for HIT in Arizona at the end of January. It turns out that largest HIE in Arizona also plans on providing view only access to data. As a physician as well as a strong proponent of electronic information exchange, I am disappointed that more robust ways of freeing up patient information flow is not the goal of most HIE programs around the country.

The "view only" option for HIE has numerous limitations. If the user wants to retain the information in a more permanent format, there is no convenient way to do this. The receiver must re-enter the data in their own EHR, PHR, or other information system. This relies on memory and human typing skills, both of which are subject to error. The process is time consuming and does not fit well with the workflow of busy clinicians and patients. I suppose screen shots could be saved but the data is still basically constrained in a silo. Worse yet, for those with information privacy concerns, it would be hard to keep an accurate audit trail for this method of copying patient information. Also, it would be difficult to support the creation and maintenance of a longitudinal health record for the patient. Furthermore, the data would be in a format that would not allow ready use of clinical decision support tools to improve the quality of patient care.


For the last four years I have served as a volunteer monitor at the IHE North American Connectathon. Most of the profiles I have tested belong in the Patient Care Coordination domain. To make a long story short, we test the ability of different vendors to conform to various clinical document summary specifications (medical summaries, ER referrals, Labor and delivery records, and ED physician notes to name a few. For further information see this site) and exchange those documents with information trading partners. The testing plan offers options of: view only, document import, section import, and discrete data import. The view only option allows one vendor to view another vendor's summary document on their computer screen, like pulling up a web page. As discussed above, this information is not in an easy to use format. The document import option allows the vendor to import the entire document and attach it to a patient's medical record. The workflow is similar to filing outside records received by mail or fax in a patient's paper chart, as many clinicians do today. Section import allows attachment of a section of a summary document to the patient's chart-for example the allergy section, problem list, medication list, demographic data, etc. This capability only has limited uses currently but could be used as a data source to drive a medication or problem list reconciliation engine. Discrete data import has the greatest potential to change how we do medicine. As the name implies, information at the data element level can be imported and inserted in the patient's chart. This information could then be used support CDS, prepare graphical representations of patient data, and for reconciliation activities such as reconciling a medication list. Unfortunately, the bar to pass the tests at the Connectathon has been set too low. Vendors only need to be able to support the view option. I have had conversations with fellow monitors and others and many agree it would be a valuable step forward to require vendors to support the discrete data import option. It is my belief that this is the most useful way to drive innovation and improve information exchange capabilities among different EHRs. There could be other incentives as well.


The federal government made a commitment to encouraging HIE through the State HIE Grant program. Federal policy has a considerable influence on the strategies the states are adopting. For example, it was made clear that The Direct Project specification should be adopted and implemented. I wish the ONC would put greater pressure on the state grantees to adopt options for data import as opposed to view only health information exchange. One only needs to look to the popularity of the VA sponsored "Blue Button" initiative to see that download technology is desired and used by patients and other stakeholders in the health care marketplace.