This document discusses questions that an ambulatory physician practice should consider when evaluating participation in a health information exchange organization (HIO). It provides a checklist of 11 workflow questions that address benefits to patient care, common frustrations, how participation could improve communication, and ease of use. The goal is to help practices identify specific values and potential return on investment from joining an HIO. The document emphasizes that responses will vary between HIOs and exploring local options is important.

1. HIMSS HIE inPractice Series
HIE ROI for the Ambulatory Physician Practice
Part II: Benefits to Practice Workflow
This is the second part of the HIE ROI for the Ambulatory Physician Practice series. The checklist
below provides useful questions on physician practice workflow, and can be used by an ambulatory or
physician practice in conducting due diligence and evaluating possible health information exchange
organization (HIO) participation. The goal in asking these types of questions is to identify specific,
measurable values for the practice. This should ideally translate into return on investment (ROI),
making the participation worthwhile.
As you apply this checklist to your decision-making process, please remember that HIO service
offerings will vary from one organization to another. It will be important to explore the specific services
offered by HIOs available in your area as you assess the ROI of participation for your practice.
Workflow Questions
Questions that will be addressed in this installment of the series include:
1 What are the patient care goals that warrant participation in an HIO?
2 What common frustrations with physician practice workflow could be addressed through
participation in an HIO?
3 How will my participation in an HIO benefit my patients?
4 How will I know about a patient’s visit to other care practitioners or health systems?
5 When and why would I access and use the data available to me from an HIO?
6 How will I communicate with other physician practices which are part of the HIO?
(e.g., sending referrals or receiving diagnostic test results)
7 How will an HIO assist me in reporting required data to public agencies at the local, state and
federal levels? (e.g., Centers for Disease Control, immunization registries)
8 How could an HIO help me to communicate more easily with my patients outside of office hours,
if this becomes necessary?
9 What concerns do other physicians have with direct electronic communication with their patients?
10 How easy will it be for me to either submit data to or obtain data from the HIO? How many extra
clicks, usernames and passwords will need to be managed for HIO exchange services?
11 Should I just wait until the HIO is up and running to participate? Is this a good option?
© 2012 Healthcare Information and Management Systems Society (HIMSS) 1

2. HIMSS HIE inPractice Series
Workflow Questions Examples of Responses & Discussion Points
1. What are the patient care Patient care goals may be determined by each physician participant,
goals that warrant specifically for an individual practice, or with all of the collaborating
participation in an HIO? physician practices. For example, one drive for HIO services may be
a desire for better management of specific diseases within the local
healthcare community.
Some HIOs are initially funded to achieve specific and measurable
patient care improvement goals relating to quality, cost-efficiency
and population health. HIOs often describe these capabilities in
terms of the various “use cases” or “user stories” that their services
support.
Goals related to specific healthcare outcomes are typically prioritized
by that HIO’s community of stakeholders.
2. What common A few examples:
frustrations with
 Providers are often frustrated with the variations in data
physician practice
requirements for specialists to whom their patients are referred.
workflow could be
Often, each specialist requires that their own unique form be
addressed through
completed.
participation in an HIO?
 Providers gain from an organized, standardized process of data
exchange across statewide, regional and local exchange
initiatives. This differs from some of the current activities that
send patient information between healthcare providers involving
variations in form, format and data context. The practice saves
time through unified and simplified data exchange requirements
and support processes.
 HIOs can reduce duplication of services, resulting in lower
healthcare costs.
 An HIO may provide the means to reduce operational costs by
automating many administrative tasks and reducing the expenses
of software system interfaces to multiple data sources (e.g.,
eliminating the need for each provider to purchase their own
interfaces with labs, immunization registries, etc.).
3. How will my Clinical information sharing improves the quality of patient care
participation in an HIO received, as providers are afforded quick access to existing patient
benefit my patients? and clinical information for both new and existing patients.
© 2012 Healthcare Information and Management Systems Society (HIMSS) 2

3. HIMSS HIE inPractice Series
Workflow Questions Examples of Responses & Discussion Points
HIO services may:
 Provide quick access to available medical histories, saving staff
time and using more efficient workflows to electronically
exchange data.
→ Current workflows may require faxing requests for medical
information, following up on requests manually, and filing
or scanning the received data into the patient’s paper chart.
 Save patient time in requesting medical records to share across
multiple providers.
→ Requests for medical records using HIOs can be made
directly between practices, making it easier for a patient to
request medical records from previous providers.
 Promote more effective clinical decision support among
providers by enabling access to a broader range of clinical
information on the patient.
 Reduce patient frustration and patient financial expenditures by
making results of past procedures accessible by all providers, so
there is no need to repeat procedures or tests.
 Improve patient care quality and reduce potential errors by
enabling provider access to all patient information across all care
providers, including hospitalizations and discharges, current
medication lists, and relevant medical histories.
4. How will I know about a The provider can be alerted, prompted to inquire, or receive secure
patient’s visit to other electronic communication about all patient healthcare visits to those
care practitioners or providers engaged in that specific patient’s care. Only those
health systems? providers who are participating with the same HIO will be able to
share patient information with one another.
 Secure communication between the HIO’s participating
providers delivers timely patient treatment information.
 Electronic exchange of Summary of Care Records within the
HIO community of care provides electronic information which
can be integrated into the individual doctor’s EHR system.
 If the functionality exists, a provider can query an HIO to find
available health information relevant to a specific patient.
© 2012 Healthcare Information and Management Systems Society (HIMSS) 3

4. HIMSS HIE inPractice Series
Workflow Questions Examples of Responses & Discussion Points
5. When and why would I Healthcare providers may need to access information available
access and use the data through an HIO for a number of reasons, such as:
available to me from the
 To learn more clinically relevant information about a current
HIO?
patient.
 To efficiently access and make available clinical information
about a patient who is being transitioned to a hospital or other
provider of care.
 To submit performance reports on specific quality measures
(e.g., number of patients within a defined treatment population
who received the prescribed treatment).
 To access results of previous tests (e.g., lab or radiology reports),
thus avoiding the costs of redundant testing, reducing time
required to make effective clinical decisions, and reducing
patient overexposure to unnecessary testing procedures and/or
radiation.
 To review aggregated data from various sources on specific
diseases within a patient population, improving the practice of
evidence-based medicine.
 To analyze their own clinical performance compared to state and
national guidelines, based on the data captured in EHRs and
submitted to the HIO.
 To access data available from public health agencies (e.g.,
immunization history and recommendations).
6. How will I communicate Various capabilities are available for sharing relevant patient
with other physician information. Depending upon individual HIO service offerings, one
practices which are part or more of the following communication methods may be used:
of the HIO?
 EHR applications which are fully integrated with the HIO’s
software could offer one-click access to relevant and accurate
(e.g., sending referrals or
patient information.
receiving diagnostic test
results)  Providers who do not use EHRs but do have Internet access may
utilize the HIO’s web portal to request relevant health
information (e.g., specialist reports, test results) by logging in as
an authenticated user.
 The doctor could send a referral to another doctor within the HIO
© 2012 Healthcare Information and Management Systems Society (HIMSS) 4

5. HIMSS HIE inPractice Series
Workflow Questions Examples of Responses & Discussion Points
network either directly from an integrated EHR, or as an
attachment through a secure electronic messaging capability.
Benefits to these methods over traditional paper and fax processes
include:
 Ease of sharing
 Reduced administrative costs
 Simplified processes without the need for multiple point-to-point
interfaces between different systems
 Speed of sending and receiving referrals, test results and other
patient information
7. How does an HIO assist The HIO may offer services that support reporting public health,
participating providers in population surveillance, immunization and other data to identified
sharing required data registries and other through data collection, redirection services and
with public agencies, data exchange services.
such as immunization
registries or the CDC?
8. How could an HIO help Not all HIOs provide communication services between physicians
me to communicate more and their patients, and physicians may not require or desire to have
easily with my patients electronic communication with their patients outside of regular office
outside of office hours, if hours.
this becomes necessary? However, if such communication is desired or becomes necessary,
there are several approaches to electronic communication channels
between physicians and patients, including:
 Patient Portals
→ Normally web-based and tethered to a specific HIO.
→ Patients can review and comment on possible discrepancies
in their medical history. They cannot make edits such as
changing, adding or deleting history. Providers will be able
to review these comments.
→ Can provide secure messaging between provider and patient.
 Personal Health Records (PHR)
→ Some PHRs can be tethered to specific provider, payer and
third-party organizations.
→ May not have an interface with the HIO.
→ Can provide secure messaging between provider and patient.
© 2012 Healthcare Information and Management Systems Society (HIMSS) 5

6. HIMSS HIE inPractice Series
Workflow Questions Examples of Responses & Discussion Points
9. What concerns do other Some concerns include:
physicians have with
 Privacy concerns
direct electronic
communication with  Inclusion and integration of email volume into their workflow
their patients? and clinical practice activities
 Chargeable services for electronic consults
→ Online / electronic consults are not necessarily reimbursable
by payers. However, it should be noted that some providers
have embraced electronic consultations by charging a fee
for each e-consult, or requiring an annual fee for online
communications.
10. How easy will it be for The ease of data submission to the HIO is governed by the specific
me to either submit data types of interfaces, which are developed between the HIO and EHR
to or obtain data from the vendors.
HIO? Some vendors have a high level of integration with HIOs, which
means the provider is able to click from within a displayed patient
How many extra clicks, chart to request additional patient information of clinical relevance.
usernames and A “click-through” capability from within the EHR enhances the
passwords will need to practice workflow, and saves time and effort. This eliminates the
be managed? staff time and labor costs involved in faxing, copying, scanning,
uploading and relabeling of patient records into a paper-based
system.
Other EHR vendors have a less robust integration, which may
require a separate user ID and password in order to log into an HIO
portal.
11. Should I just wait until Providers should aim to be involved from the earliest stages of
the HIO is up and development, in order to help identify and prioritize the services of
running to participate? highest value to them. This can set the priorities for the HIO, so that
Is this a good option? the services delivered are not only of high clinical value, but also
smoothly integrate with the provider’s workflow so as to improve the
efficiency of delivering medical care.
The remainder of this ROI series provides additional information on questions that may be asked by a
physician practice evaluating HIO participation. Continue to Part III for questions that help to identify
data management benefits through the use of HIE services.
© 2012 Healthcare Information and Management Systems Society (HIMSS) 6

7. HIMSS HIE inPractice Series
Acknowledgements
Primary Author
Marie Richards, Ed.D., PMP
TMF Health Quality Institute
marie.richards@tmf.org
Contributing Authors
Balaiah Balasubramani Chris Clark, MBA
GE Healthcare State of West Virginia
balasubramani.balaiah@ge.com Chris.R.Clark@wv.gov
Martha Dameron, RN, MSN, FHIMSS Jeff Hoy
Dameronw@comcast.net Huntsville Hospital
Jeff.Hoy@hhsys.org
R. Lenel James, MBA, CPHIT, CPEHR Robert Levy, MA, PMP
Blue Cross and Blue Shield Association ASM Research, Inc.
lenel.james@bcbsa.com Robert.Levy@asmr.com
Nancy Lush Anthony Nuzzo
Lush Group, Inc. Prosch Consulting
nancy.lush@lgisoftware.com anthony.nuzzo@proschconsulting.com
Helena Taylor Wayne Thompson
MedAllies The Commonwealth Medical College
htaylor@medallies.com wthompson@tcmedc.org
HIMSS Staff
Pam Matthews, RN, MBA, CPHIMS, FHIMSS Julie Moffitt
Senior Director, Regional Affairs – HIMSS Coordinator, Regional Affairs – HIMSS
pmatthews@himss.org jmoffitt@himss.org
The inclusion of an organization name, product or service in this publication should not be construed as
a HIMSS endorsement of such organization, product or service, nor is the failure to include an
organization name, product or service to be construed as disapproval. The views expressed in this white
paper are those of the authors and do not necessarily reflect the views of HIMSS.
© 2012 Healthcare Information and Management Systems Society (HIMSS) 7