their information remotely. Some PHRs can be populated with information from a variety of sources (e.g., provider EHRs, insurance claims, pharmacy data) to provide a more complete picture of the patient’s health-related information (Table 5-1) (CMS, 2012a; Detmer et al., 2008; HHS, 2008).
The full benefits of health IT cannot be realized without an infrastructure that supports the secure exchange of health information beyond an individual provider or health care delivery system. Health information exchange (HIE) enables the electronic sharing of patient-level health information across organizations and health IT products (principally EHRs and PHRs) using nationally recognized interoperability standards (HHS, 2008). HIE is a solution to barriers to the exchange of health information across organizations posed by the fragmented health care system (HHS, 2008; Vest et al., 2011). HIE gives providers access to more accurate and complete information on their patients and, thus, may help to improve the safety and quality of care (CBO, 2008; Vest et al., 2011; Wright et al., 2010). A number of regional health information organizations (RHIOs) across the country have developed networks to enable secure HIE among local clinicians, provider organizations, pharmacies, laboratories, health departments and other entities (Shapiro et al., 2011).
When used appropriately, health IT has the potential to generate savings. For example, health IT could result in savings by lowering the costs of providing health care, eliminating unnecessary services (e.g., duplicate tests), and improving care quality in a way that may reduce costs. Savings may be internal in the form of reductions in the costs of providing care for health care providers directly. Savings also can be external, meaning the savings accrue beyond individual providers to other providers, patients, health insurance plans, or others—for example, from increased ability of participants to engage in HIE (CBO, 2008). As discussed below, compared with large integrated health organizations, small provider groups may be less likely to internalize the financial benefits from health IT because there is less incentive for improvements in administrative efficiency and because costs are distributed across a smaller number of providers and patients (PCAST, 2010).
Uses of Health Information Technology for the Collection
of HIV Care Data and Management of HIV Care
Clinical data needed to monitor indicators of HIV care are often contained in EHRs or EMRs. As discussed in Chapter 2, clinical data include information on individuals’ health status, findings from examinations, and medical history information. EHRs and EMRs also document patient demographic information such as sex, date of birth, insurance status, and race and ethnicity. Stand-alone and EHR- or EMR-embedded CPOE applica-