Two Distinct Uses of HIE Creates Acronym Confusion

William A. Hyman
Professor Emeritus, Biomedical Engineering
Texas A&M University

The use of acronyms and abbreviations has been decried in healthcare because of the potential for confusion when they are misunderstood. So now we have HIE which means, variously, Health Insurance Exchange, or Health Information Exchange.

The Affordable Care Act has mandated Health Insurance Exchanges (HIE) which are to be new state systems, or a default federal system, to facilitate consumer comparison and selection of health insurance products. They are supposed to foster competition and make policies more readily available for individual buyers and small businesses. At this time some states have opted in and are developing their own systems. Other states have aggressively (and politically) opted out in which case the federal government will develop and manage that states HIE. As of January 6, 2013, the New York Times put the opt out count at 26 (mostly under Republican leadership), the state systems at 17, and state-federal partnerships at 7. Putting the politics of opting out aside, it is a worthwhile debate whether each state creating a more-or-less similar system is more efficient than a single federal system. Or are there really significant state-to-state differences? Or is big software always a relatively bad idea compared to smaller projects. Note that the latter is also part of the ongoing EHR struggle. Should there have been a single federally created or endorsed EHR (the VA’s VISTA, with some work, has been suggested) or is the current system of multiple private EHR vendors the better approach? With private vendors comes the challenge of HIE. No, not Health Insurance Exchanges this time but Health Information Exchange (see below). Given that we have gone the multiple vendor route, with increasing Meaningful Use requirements and vendor fallout, there may end up being only a few EHRs anyway. Whether many or few, making them “talk” to each other is an ongoing issue, which leads us to Health Information Exchange.

Health Information Exchange (HIE) is part of the EHR meaningful use (MU) requirements for federal incentive funding. The idea here is that patient EHR data should be readily movable by electronic means (and that doesn’t include fax) for at least two purposes. One is so that patient data would be readily available in fully usable form to the various providers that a patient may interact with including both doctors and hospitals. This is a key element of the quality of care value asserted for EHRs. A second purpose of information exchange is that of creating a public health level of shared information through which trends can be tracked, and health statistics generated. It has also been suggested that large data pools could be used for chart based research. While chart review has always been a research tool, doing it with paper charts has been daunting at best. Sufficiently large organizations (e.g. Kaiser has 9 million patients) could do this with their own data, but those without such data might benefit from a pooled resource. And if valid information emerges from the pooled data, we all benefit.

So we have two distinct HIEs, but there is perhaps some hope for greater clarity. Having created the Health Insurance Exchange label, the federal government announced on January 16, 2013 that it was seeking to rebrand these HIEs as Health Insurance Marketplaces, with the now sexist acronym HIM. But this acronym is suitable payback for a problem at least I have. Every time I type EHR Microsoft WORD® changes it to HER. I suppose there must be a way to make this not happen, but I haven’t figured it out yet. Beyond that issue, the plural of HIM is obviously HIMs, which at least verbally is the same as HiMSS, providing for possible spoken confusion between the Marketplace (aka Exchange), and the professional society. Perhaps one can look forward to a session on HIMS at HiMSS.

Others have also sought to deal with the acronym problem. HIX has previously been suggested as an alternative for Health Insurance Exchange but I have not seen this widely adopted. Nor is it obvious why HIX works better for the insurance arena than it does for the information arena. The HITECH Answers’ acronym list also offers HIM as Health Information Management so maybe HIM was already taken.

While acronym gamesmanship should be only a superficial issue, there is enough confusion without creating more unnecessarily.