While some states are struggling with creating a framework for health information exchange, others are developing collaborative efforts within regions of their respective borders.

Look at New York, for example. Not only are a number of regional health information exchange efforts underway, work is also being done at the state level to form the State Health Information Network of New York (SHIN-NY). And in the borough of Brooklyn, the Brooklyn Health Information Exchange (BHIX) has successfully started exchanging health information.

BHIX's structure

According to BHIX's executive director Irene Koch, two hospitals, four nursing homes, three home care entities and two payers provided initial support for the BHIX project. "We have certainly grown since then, but the exchange was intended to facilitate communications of information across the continuum of care. The original stakeholders reflect that principle, having clinicians at every point of transfer of care with the patient," she said.

Information is now being exchanged, as the project has moved from its first grant, awarded in 2005, and the first exchange of demographics, provider/care team information, medications, allergies, advanced directives, diagnoses and procedures, beginning last year. "Going forward, we will be exchanging that data and expanding to other data types, as well," Koch said. BHIX was established in 2007 as an independent, non-profit New York organization; at the end of 2008, it began exchanging information successfully.

The original phase of the exchange is occurring with and between users and data sources in Brooklyn, but the organizations' expanded membership includes providers and payers in other boroughs within New York City. "We are also actively involved with the work of SHIN-NY, and by working collaboratively with other projects and organizations in the state and the New York City Department of Health and Mental Hygiene, we are looking to push forward with the rollout of SHIN-NY. BHIX will be a core participant in that effort," she said.

As part of that expansion phase, BHIX recognized the need to create a solid infrastructure and sought out the services of Cambridge, Mass.-based InterSystems Corp. "In our expansion phase, we assessed what we believed we were going to need to form a solid infrastructure that would grow and change over time as the protocols and services related to health information exchange matured," Koch noted. "For our expansion phase, we decided to change our infrastructure, and we are migrating from our initial platform to the InterSystems infrastructure that will be based on the company's HealthShare technology; allowing us to deliver the technology in a much more protocol-focused and flexible manner."