Health Record Banking - Adding Value to Health Information Exchange
HRBA believes that integrating Health Record Banks into HIEs has the following advantages.
Patient-empowered...Added Value...Secure...For Life
These notes were developed to provide information for decision makers, particularly state and regional HIE coordinators and federal staff, who are responsible for policy and strategy regarding health information exchange. The comparison looks primarily at a Community HIE; however, enterprise (or private) HIEs have many of the same characteristics as a Community HIE.
An HIE’s success relies on cooperation, usually voluntary cooperation, of the stakeholders. Voluntary cooperation makes the process of negotiating and maintaining legal data sharing agreements more difficult. Adding to the complexity are competitive and sometimes distrustful relationships among the stakeholders. An HIE is “about” the patient but is responsible to the stakeholders. With an HRB, no provider-to-provider sharing agreements are necessary. The patient controls the information and requests/directs providers to send information to the HRB. Each patient determines who is appropriate to view their information in support of their care and health. A HRB is “for” the patient and owned by the patient.
The addition of HRB functions can add or enhance revenue streams from payers, providers and research organizations. Based on a sample of 25 HIEs, their median revenue is about $6M, with median expenses of about $3.8M annually. 15 of the HIEs have positive revenue minus expenses, and 10 were operating in the red.
HIEs provide security via an on-boarding process for non-patient participants: payers, providers, labs and radiology clinics, public health agencies, and, in a few cases, research organizations. An HRB adds the patients to the trusted community, normally via identity proofing by providers or other participants in the HIE. New security methods prevent large scale data loss.
In HIEs without an HRB component, long-term record retention is optional and often dependent on the specific providers participating. Legally, an organization usually needs to retain adult records for 7-10 years past the last patient encounter (depending on state laws). The organization or HIE is then free to delete records. With an HRB, record retention is controlled by the patient, and is available for life.
*A Community HIE connects disparate organizations while an Enterprise (private) HIE usually connects data sources within the control of a single organization.