With all innovations in healthcare, it remains common for patient information to be incomplete at the point of care. Often, multiple medical records exist, and everything from disease information to full medication lists is not shared between providers. To understand that even electronically provided patient data remains largely siloed—especially given how fluid data exchanges are in our daily lives—It helps to understand the legislation that initially sparked wider use of electronic health records.
Health Information Technology for Economic and Clinical Health (HITECH) was signed into law in 2009, requiring health systems to implement the use of EHRs. question? There is no requirement to standardize the EHR to ensure that data can be shared between different electronic health records before widespread adoption.
“Why do we have no standards before we start doing this, it’s always a shame?” said Dr. Douglas McKee, chief medical information officer and vice president of Health First in Central Florida.
Today, health systems are prioritizing improving interoperability between EHRs and aggregating patient data for a more complete picture. Depending on demand and necessity, EHRs and other vendors have followed suit.The government is also helping this process by adopting new standards such as Fast Healthcare Interoperability Resourcestuner) describes how healthcare information is exchanged.
But full interoperability and data standardization remain the holy grail: mysterious and elusive. As a result, hospitals are employing different strategies to break down data silos to bring more complete patient data to clinicians’ fingertips and improve care.
McKee said one of the most important things Health First is doing in this regard is partnering with companies Have, which creates software that brings together patient data from disparate sources. Even within Health First’s comprehensive care delivery network — which includes four hospitals, outpatient services, hospice and pharmacy — there are two primary EHRs. Health First uses Allscripts for acute care when patients come to the hospital and relies on athenahealth in an outpatient setting. So Health First’s initial effort with Tendo involved connecting its two main EHR systems so patient data was displayed in one place, McKee said.
“Unsurprisingly, there is a lot of different and incoherent information about a person’s health,” said Jennifer Goldsmith, Tendo president and co-founder.
But it turns out that most health system problems start within.
“Almost all healthcare systems today have multiple EMRs,” Goldsmith said. “It’s really a remnant of the rapid acquisition of different healthcare systems” — each with their own medical records software from a different EHR vendor.
Countless EHR system issues resolve themselves over time as acquired entities migrate to one EHR system. But not all health systems see the need for a unified EHR across their hospitals and clinics. Take health first, for example.
McKee said he has not been able to say what caused Health First to have two EHRs since the decision was made many years ago. But Health First doesn’t have any plans to integrate into a single system-wide EHR.
“We plan to use Tendo to bridge the gap between EHRs,” McKee said.
In addition to sharing data among its own EHRs, Health First is focusing on bringing in patient data from external providers through health information exchanges and connectors, such as Cornwell and quality of care Even consumer apps like Apple Health. a major pThe purpose of working with Tendo is not only to connect disparate information for providers, but to bring them together in a very patient-friendly format. Patients will be able to access their information through an easy-to-use user interface in the Tendo app, McKee said, adding that it is still in development.
other health systems such as Intermountain Healthcare In Utah, they are busy trying to break down the barriers of information exchange not only for themselves, but for all hospitals.
Find solutions for all hospitals
Stan Huff, Intermountain’s chief medical information officer, said this has formed in two main ways.
On the one hand, “wThey are developing a digital platform of the future…an overriding project to create a truly interoperable based infrastructure,‘ said Huff.
another involves Graphite Health, a non-profit company launched last October with the stated goal of accelerating the digital transformation of healthcare. Currently, the organization is led by four members – Intermountain, Kaiser Permanente, SSM Health and Presbyterian Healthcare Services.
Graphite Health’s goal is to create a standardized, interoperable data platform for a secure and open marketplace that makes it easier to distribute digital health solutions for health systems and entrepreneurs.
“Once you normalize the data, you can do more than just support this open market,” Huff said. “It also creates properly approved data that can be shared across organizations for patient care. ”
Intermountain is now able to partner with outside hospitals through the Utah Health Information Network (UHIN). But even where information can be shared freely, faxed reports are still common, he said. This can leave clinicians with no precious time scrambling to try to quickly find the information they are looking for in long reports. Now is the best time to spend with patients, Huff said.
“So you really want to integrate the information into the application to automate data retrieval electronically in seconds,” Huff said.
He points out that in some areas, the standardization of data goes further, such as Laboratory results or drug data. In the latter case, standardization is needed as e-prescribing has largely become the default. But the ideal would ultimately be for all patient data to be normalized when or immediately after being entered into the EHR, he said. This will allow any health organization providing care to patients in the future to access it without encountering technical barriers.
The role of health information exchange
Currently, some exchanges are trying to fill the void. In addition to some public or non-profit exchanges for this purpose, the EHR has created a network of private exchanges to allow for more data sharing between different health organizations using the same or different platforms. epic, Athena Health and electronic clinical work Was one of the early major EHR adopters of the Quality of Care Interoperability Framework. scriptAthena Health, Serna, McKesson Helped create CommonWell.
But a new government framework is seeking to formalize, standardize and accelerate the development of health communication. In January, the Trusted Exchange Framework and Common Agreement (TEFCA) was published, setting out the requirements for how entities can be designated as Qualified Health Information Networks.
that’s something Dr. Eric Alper, Senior Vice President, Chief Clinical Information Officer and Chief Quality Officer UMass Memorial Healthis being watched closely. Currently, the University of Massachusetts in Worcester, Massachusetts, utilizes private health information exchanges such as Epic’s proprietary Care Everywhere platform.
Care Everywhere allows UMass to have a very powerful communication with other hospitals and health systems that use Epic, Alper said. It also allows UMass to exchange with many non-Epic systems by connecting to entities such as quality of carethis eHealth Exchange now even Cornwell.
“The quality of the data wasn’t that great, and the quantity wasn’t that robust…but it gave us an initial look at the patient’s medical history,” he said.
Over the past five years, UMass completed about 15 million data-sharing transactions across all 50 states and 400 health organizations that use Epic, with nearly 6.5 million of those transactions in the last year, he said.
But he added that there are still blind spots where UMass is looking to improve data sharing. This includes a slow pace of pre-authorization to ensure patients can continue to receive treatment covered by insurance. Health systems are evaluating software programs that can more easily exchange patient data to greatly speed up the process.
epic has prior authorization ability with certain payers, But Alper noted that EHR providers don’t work with many payers in UMass’s regions. While he wasn’t involved in UMass’ analysis of pre-authorization tools, and said he’s not an expert on all the options available, Alper believes that other vendors have more experience with pre-authorization software than Epic. However, he fully expects the Wisconsin EHR behemoth to expand its software solutions to meet this pressing need.
“Prior authorization can be one of the biggest sources of burnout and frustration among our physicians and other clinical staff,” Alper said.
Another type of patient data that UMass has started to receive externally is imaging. health system use PowerShare from Microsoft Nuance, a tool that allows the exchange of radiology research.Therefore, if a patient has a CT scan at another hospital, the radiologists, surgeons and oncologists at UMass These can be accessed, Alper said.
The long road to interoperability
Taken together, the lack of standardization in the past, the cobbled together hurdles of today’s data-sharing initiatives, and future ambitions for universal interoperability are all daunting propositions.
The vision for full standardization and interoperability of patient data will not happen overnight. For example, it will pProbably at least a year earlier than Graphite, The nonprofit is focused on overcoming healthcare interoperability challenges, There will be a platform available, Huff said.
“People need to realize how difficult this is,” he said. “People don’t like to hear it, but it will take five to ten years to start realizing that vision. “
If full interoperability is achieved, both health systems and patients will benefit.
“Even though it’s been a long journey, it’s going to be well worth it,” Huff said. “Ultimately, it’s all about taking better care of patients and doing it at the lowest possible cost.”
Photo: marchmeena29, Getty Images
