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HIEs Will Allow Patients and Practitioners to Share Data



To qualify for the incentive payments established by the HITECH Act, users of electronic medical records must demonstrate “meaningful use,” which is being implemented in three stages. Stage 2 Meaningful Use standards, which will go into effect in 2014, require connectivity among all care providers and with patients themselves. This will be achieved by electronically transmitting patient health records (PHRs) and continuity of care documents (CCDs) via the internet through health information exchanges (HIE).

However, many of those involved in both the development and use of EMR observe that the use of HIEs hasn’t quite caught on…yet. However, because it is a requirement of the HITECH Act, eventually it will.

“The ability is out there for health information exchanges, but in our profession, not many people are using them,” said Adam P. Parker, OD, of Drs. Robinson & Parker in Midlothian, Va.

“There’s s still a lot to be figured out with health information exchanges. For example, the government requires that you send the CCD, but it doesn’t even include glasses or contact lenses prescriptions, so it’s somewhat inefficient for optical doctors,” said David H. Hettler, OD, of May & Hettler of Alexandria, Va.

Patients are also slow to adopt HIEs. “We’re not seeing great demand for patient access,” said Anthony S. Diecidue, OD, president/CEO of Mountain Computer Systems, makers of Eyebase software.

Still, it’s coming, and just as once cutting-edge EMRs are now becoming commonplace, so too will HIEs. “HIE is something that’s starting to happen, but it’s slow going because it’s on a state-by-state basis, and each state has different protocols…but it is happening,” said Korry Petterson, president of software developer FoxFireSystems Group in Sioux Falls, S.D.


 To achieve Stage 2 Meaningful Use, ECPs will be required to transmit patient health records and continuity of care documents through health information exchanges.  

Because the ability to communicate via an HIE is required of certified EMRs, some say that this is something ECPs don’t have to concern themselves with. “Optometrists should not worry too much about HIE,” said Chris Moore, CEO, Integrity EMR. “Any system they choose has to be certified, and in order to be certified it has to communicate with HIE.”

Still, the ability to share information among all of the doctors responsible for a patient’s care as well as with the patients themselves is one of the primary goals of the implementation of EMR, so it’s already starting to catch on among general practitioners. According to CapSite’s 4th Annual U.S. Ambulatory Electronic Health Record & Practice Management Study published in September and focusing on assessing the impact of the HITECH Act, 43 percent of U.S. physician groups plan to join an HIE.

For patients, online access to medical records and secure e-mail communication leads to increased office visits, according to a five-year study concluded in 2010 by Ted E. Palen, MD, PhD, MSPH, of the Institute for Health Research, Kaiser Permanente Colorado, Denver.

A staunch proponent of the implementation of HIEs is Alistair Jackson, VP, business development, EMRlogic Systems Inc. He predicts that in order for optometrists to be able to participate on the care team it will be necessary for them to share information over HIEs. “Optometrists need to be proactive, otherwise they’ll lose access to their own patients,” he said. On his blog at, which explains the core tenets of meaningful use and details his views regarding the ultimate purposes of EMR, he encourages optometrists to, “Get informed, engaged and empowered as a provider before your patients start asking you for things they expect you should know about well ahead of them.”

He also described the Direct protocol for communicating via HIEs: “As you learn more about your state Health Information Exchange, you’ll uncover a whole new network of regulations and protocols akin to what we’ve all gone through thus far to achieve certification and meaningful use attestation. Since the HIE is all about exchanging health information, you’d expect—and indeed find—an approved encrypted transmission protocol. That’s ONC Direct. And that’s what Health Information Service Providers must use.”

AOAExcel XNetwork

As an alternative to HIEs, the American Optometric Association’s wholly owned subsidiary AOAExcel will launch the AOAExcel XNetwork in the first quarter of 2013. It will enable ECPs to connect electronically to physicians, hospitals and their ancillaries, pharmacies, payers, benefit managers, optical labs, medical labs, imaging and radiology services, employer human resource departments, home care providers, and with patients themselves.

Primarily for practitioners who are not members of health information exchanges (HIE), the AOAExcel XNetwork will offer health information technology (HIT) networking, connectivity and secure patient communications services for optometric practices. The XNetwork services are being developed in conjunction with AT&T as part of its Healthcare Community Online program. AT&T already offers similar services for medical doctors and hospitals.

“The XNetwork is not an EHR software program but rather a network that can be used to connect the EHR in an optometrist’s office with EHRs in other health care practices or facilities and thereby allow for the exchange of patient information among them,” said Ian Lane, OD, AOAExcel chief medical information officer. According to the AOA, it can be used with virtually any commonly available EHR software program.

“It will effectively ensure that optometrists who wish to meet Stage 2 standards and thereby qualify for federal incentive bonuses will be able to have the required connectivity,” said Joe Ellis, OD, AOA Excel chair and past president of the AOA. While the XNetwork is being developed largely to ensure interoperability and connectivity for practitioners who are not HIE members, or for those who may not have access to HIE services by the time Stage 2 compliance is required under federal incentive programs in 2014, Ellis believes even many ECPs with HIE access will subscribe to the XNetwork to ensure connectivity with health care practitioners and institutions that cannot be accessed through their HIEs.

Even for optometrists using EMR systems that may have achieved Meaningful Use Stage 1 but are unable to achieve Meaningful Use Stage 2, those that Lane described as “certified for meaningful use but not meaningfully useful,” the XNetwork will enable them to have the connectivity necessary to achieve Meaningful Use Stage 2.

Whether optometrists are ready or not, electronic medical records are quickly becoming the norm and the health information exchanges that enable them to electronically share information are following close behind. Those ODs who are proactive will surely reap the benefits sooner than those that lag behind and need to catch up later.