This guidebook is based on a project designing, implementing, assessing, and refining the use of local Health Information Exchange (HIE) hubs connected to a Regional Health Information Organization (RHIO) in Oklahoma using SMRTNET (September 2007–March 2012). The project involved six primary care practices using different installations of the same EHR. By the end of 2012, more than 70,000 patient records had been processed from these practices.

The project was funded by the Agency for Healthcare Research and Quality to test the feasibility and impact of HIE and the provision of decision support via a RHIO on the delivery of recommended preventive services and other components of primary care such as laboratory test use, medication reconciliation, and coordination of care.

This guidebook introduces you to:

• Connecting an electronic health record (EHR) to a local HIE hub and an RHIO.
• Incorporating HIE into the clinical practices and workflows of providers using EHRs.
• Connecting clinical decision support to an aggregate HIE database via the Preventive Services Reminder System (PSRS).
• Using the principles of organizational change to implement the connection between clinical decision support, PSRS, and HIE in provider workflows and practices.