A Practical Guide to Understanding HIE, Assessing Your Readiness and Selecting HIE Options in Minnesota

Assess: Landscape

In today’s complex health care environment, secure information exchange impacts all areas of your practice – from patient care to practice operations to reimbursement and more. When considering HIE you should first understand the types of information exchange that are of most value to you and who you would need to exchange information with to realize that value. This is your HIE landscape.

On this page:
Types of Information Exchange
Information Exchange and Your Practice


Types of Information Exchange

Information exchange in Minnesota can generally be considered to be of two types: push and pull. Both types may involve more complex processes that occur behind the scenes of your EHR system, but the terms push and pull cover the main concepts. One key difference is who is initiating the exchange of information: for a push transaction the sender initiates the exchange of information, and for a pull the recipient initiates the exchange of information. You, as the provider, could be both the sender and the receiver, even in the same transaction. The definitions and scenarios below will help illustrate these concepts: 

Push: This is a secure sending of information between two known entities with an established business relationship, such as a primary care provider and a specialist. These types of transactions typically relate to routine workflow and processes. A non-health care example of a push transaction would be sending an email.

Pull: This is a secure accessing of information that involves a query and a response. The query is the request for information about a patient, and the response is the retrieval of clinical information on the patient or information on where the clinical data can be found. For example, conducting a Google web search is a non-health care example of a pull transaction.

HIE push transactions
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Information Exchange and Your Practice

As you think about how HIE can benefit your practice, it may be helpful to first document the ways information moves into and out of your practice, whether manually (e.g., phone calls, letters, fax) or electronically (e.g., billing, e-prescribing). HIE opens up new possibilities so think about what you want to share, with whom, and what that information flow into and out of your practice might look like. 

While meaningful use requirements may be the focus of your HIE planning, other types of exchange may also be very important to you.  The following scenarios may help you understand the value of HIE for your practice or organization. You can find additional exchange options in the Information Exchange Priorities table.

Scenario 1

Provider Sends/Pushes Immunization Record to the State Immunization Registry
A child arrives for a routine appointment and the provider’s office staff uses their EHR to determine that immunizations are due. After the vaccines are administered, the information is recorded in the EHR system, which automatically sends an update to MIIC (Minnesota Immunization Information Connection), Minnesota’s immunization registry. (This is a Stage 1 and Stage 2 meaningful use example.)

Scenario 2 Laboratory Sends/Pushes Lab Results to Ordering Provider
The contracted laboratory’s LIS (laboratory information system) creates preliminary, final, and amended laboratory test results relating to a specific clinical test order. The LIS sends each incremental lab test result to the ordering physician, which can be incorporated into that provider’s EHR and flagged for review.
Scenario 3

Long-Term Care Facility Queries/Pulls for a Medication History
A new patient arrives at a long-term care facility with only partial records and an incomplete medication history. Nursing staff at the facility obtain appropriate patient consent and submit a query through an intermediary such as a health information exchange service provider they have a contract with, which has a patient record locator service. The HIE service provider locates the patient’s records, aggregates the results, and makes the results available to the long-term care facility. Results can be incorporated into the EHR either manually or automatically depending on the type of EHR used and workflow processes.  

Scenario 4

Provider Queries/Pulls for Information for a New Patient
Dr. Miller has a new dental patient, Ms. Jones. As part of the workflow for that patient, Dr. Miller needs more information about Ms. Jones’ cardiac condition before scheduling dental implants. A secure message is sent to Ms. Jones’s cardiology clinic requesting a summary of patient’s current conditions and medications. The cardiology clinic provides (pushes) the information back to the dental clinic. (Note: this query is actually accomplished through two push transactions.)     

Scenario 5

Provider Queries/Pulls the State Immunization Registry (compare to scenario 1 above)
A child arrives for a routine appointment and the provider’s office staff uses their EHR to automatically query the statewide immunization registry (the Minnesota Immunization Information Connection or MIIC). MIIC returns both a consolidated immunization history for the child and recommendations indicating that the child is due for a number of immunizations. After the vaccines are administered, the information is recorded in the EHR system, which automatically sends an update to MIIC on the vaccines that were administered.

While these information exchange transactions may sound simple, developing the EHR system capabilities to support them is complex. Rather than trying to build capabilities for every potential health information transaction, we recommend prioritizing those that will bring the most value to your practice or organization. 

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Updated Thursday, July 11, 2013 at 10:28AM