Health Network Terms

Networks for exchanging health related information are essential to aggregating patient-focused information into EHRs and PHRs as well as to developing a population-based approach to improving care practices and preventing illness. These networks are beginning to take shape in localities and regions around the nation, and there is a need to enable these networks and their participants to exchange health-related information electronically on a widespread, interoperable basis with appropriate privacy, security, and confidentiality safeguards in place.

Nationally recognized interoperability standards are a necessary component of the definitions for the records terms. However, the network terms require interoperability plus an additional set of nationally recognized standards to enable the flow of information reliably, consistently, accurately and securely. This concept is reflected in the definitions.

The terms that facilitate understanding of the concepts closely associated with building health information exchange networks must address two principal components of a network endeavor:

                The process of sharing health-related information using nationally recognized standards.

                The need for an oversight structure to facilitate this sharing of health-related information and to be accountable for its performance.

The two terms under examination for their role in describing information networks—HIE and RHIO—address these two components, but further clarification is needed.

Eliminating Confusion. As an oversight structure, a RHIO describes a certain type of arrangement with distinct attributes relating to governance and geography. But it is not adaptable enough to suffice as a term that can encompass the wide range of organizational forms that an information-sharing structure can take, including forms yet to be envisioned. This shortcoming has led to the increasing usage of the term HIE to represent an oversight structure with the requisite flexibility. However, the term HIE at its core describes the process of sharing information. Continuing its dual meaning as the oversight structure as well as the process perpetuates confusion over the term, which runs counter to the objectives of clearly assigning meaning to each term and distinguishing one term from another in discussions about health information technology.

Proposed new term. Drawing from discussions in the Network Work Group and comments received in public forums and written public comments, two possibilities emerged and were considered; both of them are adaptations of existing health IT terms:

                Health information organization (HIO), identifiable as the root element of RHIO without the boundaries of geography assigned by the use of the modifying word regional.

                Health information exchange organization (HIEO), identifiable as the organizational entity that undertakes the oversight and governance of the HIE process.

Each alternative had significant support. In the final stage of consideration, consensus developed around HIO as more straightforward and distinguishable from HIE. HIO also lends itself to being the overarching term to describe an organization while having the built-in capacity to include a modifier for more specific identity: state-level, pediatric, behavioral, etc. It embraces RHIO as one kind of HIO while opening up the opportunity for other HIOs that are not geographically based.