Regional Health Information Exchange (RHIE)

Abstract

Health Information Exchange (HIE) is a term used to describe the sharing of health information electronically among two or more entities. These entities are mostly organizations, which provide health services to their clients (the patients) and also enable the sharing of electronic health information. The exchange of medical data takes place primarily between different medical departments within the same health organization. This happens most of the time through an Electronic Health Records (EHR) system within the organization, but also across the organizational borders on the regional level (through Regional Health Information Systems, RHIS) or across the country (National EHR). The previous efforts of the national EHR system in the Netherlands (L-EPD) had a top-down approach, based on the national architecture (i.e. AORTA). The top-down implementation of the national EHR in the Netherlands, as evidenced by the opinion of a number of Dutch experts in the field, has caused several resistance among GPs, medical specialists, patients and several other interest groups. The upcoming stakeholder analysis also reveals severe problems in this regard. Requirements analysis in a bottom-up fashion can be a practical remedy to this problem. Following this perspective, the present research tries to specify some of the viewpoints of the most important stakeholders, including the users of RHIS. It describes the functional and non-functional requirements for the regional health information exchange in the Netherlands. These requirements are based on two different questionnaires, which were designed and further conducted by the author among the primary users (i.e. medical staff) and secondary users (i.e. patients) in 2012. In addition, the interviews with several RHIS experts (representatives of almost 50% of all Dutch hospitals) and an extensive document analysis of an EHR vendor of hospital information systems revealed several constraints and complementary requirements. The primary contribution of this research is the identification and thorough analysis of the most important stakeholders, involved in the field of health information systems, their viewpoints and the existing problems with RHIS. Furthermore, it is one of first attempts to translate these findings into important usecases, real-case scenarios and a set of business goals, areas of concern and requirements. The outcomes of the research indicate that future works in this field should focus on a bottom-up approach towards gathering more specific informatio and adapting the general requirements found in this research to particular cases and contexts of use.