Category Archives: EHR Interoperability

Innovation Series

This past year I had the opportunity to share my thoughts and insights as to where we need to go in healthcare.  I still firmly believe we need to meet the patients where they want care while maintaining a complete and comprehensive accounting of their medical history and interactions with the health system as well as in their daily lives.  In this short interview I try to offer insights into interoperability, how technology impacts to our movement from volume to value, and efforts to developing a unified consortium of trust partners to safely and securely share medical information.

 

 

The Impact of the FLEX-IT Act

This past week we saw some significant controversy regarding the Meaningful Use Stage 2 Final Rule which was published late August of 2014.  The controversy lies within the reporting period. The final rule requires a full 365 days of reporting.  Many professional organizations feel that this is to arduous.  Earlier this week Congeresswoman Renee Ellmers (R-NC) introduced The Flexibility in Health IT Reporting  (Flex-IT) Act of 2014.  She states:

 

“Health Care providers have faced enormous obstacles while working to meet numerous federal requirements over the past decade. Obamacare has caused many serious problems throughout this industry, yet there are other requirements hampering the industry’s ability to function while threatening their ability to provide excellent, focused care.”

“The Meaningful Use Program has many important provisions that seek to usher our health care providers into the digital age. But instead of working with doctors and hospitals, HHS is imposing rigid mandates that will cause unbearable financial burdens on the men and women who provide care to millions of Americans. Dealing with these inflexible mandates is causing doctors, nurses, and their staff to focus more on avoiding financial penalties and less on their patients.”

“The Flex-IT Act will provide the flexibility providers need while ensuring that the goal of upgrading their technologies is still being managed. I’m excited to introduce this important bill and look forward to it quickly moving on to a vote.”

 

While I applaud Congresswoman Ellmers I personally don’t feel this is the time to ease the pressure of the transformation of healthcare.  As she states only 9 percent of our nation’s hospitals and 1 percent eligible healthcare professionals have demonstrated the ability to meet Meaningful Use Stage 2 requirements.  While I certainly don’t argue the statistics around this issue and agree that the Meaningful Use Stage 2 measures are much more difficult to tackle but most facilities both EP & EH wait until the latter part of the reporting period to attest so I can assume that the 9% number is on the low end.   The fact of the matter is that we should be properly documenting all these pieces of information regardless of an electronic record, it is just good patient care.  By easing up the restrictions on meaningful use sends the message that this pivotal moment on our journey to digitize health and further transform our collective system is not as urgent as it should be.  I just don’t think it is in the best interest of our patients.  By limiting the reporting period to 90 days as opposed to 365 is analogous to only treating the Chest Pain patients you see over a 90 day period correctly while extrapolating that the other patients treated over the next 275 days are treated just as well.  I realize that this may be an overly excessive example but I truly feel that we need to maintain the collective pressure to transform the patient care experience and focus on proper data input so patients can feel we as clinicains and the healthcare system as a whole are able to diagnose our collective patients as accurately and efficiently as possible.

Interoperability- The sub-theme of this years UGM

I had the opportunity this week to attend the Epic user group meeting.  I must tell you that the feel of collaboration around the patient care experience is nothing else I have experienced. One thing many of  the attendees may not have been aware of is the increased focused on interoperability in the next couple of years.  I have  the unique opportunity to serve as chair of the CareEverywhere Council, a group of individuals passionate about the seamless transmission of information.  Additionally I was most recently appointed to chair the CareQuality Trust Framework subgroup.  It is within these two groups I will try to drive toward the three factors that will ultimately facilitate this information transfer so patients can feel just as safe in the healthcare system as they do in their own homes. I have included the The Interoperability Report 2014 Care Everywhere Network here.  In short we must commit to:

  1. The use of industry standards
  2. A nationwide directory of exchange-ready providers
  3. Simple Rules of the Road

These rules establish a universal trust framework that outline the rights and obligations of network participants.  They would give each organization confidence that it can participate in exchange activities while upholding its legal and ethical obligations to maintain the security and privacy of patient records.

Unfortunately that single set of Rules of the Road does not exist across industry, so trust must be established individually.  In order to move beyond the one-to-one connections a framework of mutual trust agreements and standards needs to be in place.

With this in mind I have recently been appointed to chair the CareQuality Trust Framework WorkGroup.  It is here that I will continue to work with all vendors to create a framework that expedites point-to-point patient record exchange basedon mutual trust agreements and national standards

Over the past 2+ years we haven’t done everything right.  In the attached report we detail some of the touching stories of successful information transfer but also some of the issues we have uncovered.  As of August Epic has exchanged over 550,000 patient records with other non-epic vendors per month!!  That is a staggering number and one that is not accounted for in the many news stories on the perceived lack of interoperability.

Presently the CareEverywhere Network includes over 950 hospitals and over 21,000 clinics representing community hospitals. academic medical centers, children’s organizations, FQHC’s, safety net providers and multi-hospital systems all sharing critical patient information with individuals both on Epic and not.

 

Some of our lessons learned

  1. Patients overwhelmingly want to share their data in a secure way
  2. Strict adherence to fewer standards + succinct Rules of the Road + simple patient consent model = SUCCESS
  3. Providers attribute exchange success to integration with clinical workflows
  4. Nationwide exchange is practical even without a national patient identifier, and can be further improved
  5. Successful exchange does not have to be expensive and results in lower cost of care

Recommendations

  1. Simplify consent because the majority of patients want to securely share their data
  2. Simplify exchange: one standard per purpose with a single national phone book of exchange ready organizations and providers
  3. Continue to formally adopt nationally-defined reference terminologies to enhance utility of data incorporated into the local chart.
  4. Standardize how identifying information is captured to further improve patient matching between providers.
  5. Require public health and immunization registries to exchange directly with providers free of charge when using a single, national standard.

 

I look forward to my continued participation on both the CareEverywhere Governing Council as well as the new CareQuality Trust Framework Work Group.

 

A Trip to Camp

I recently had the opportunity to drive my three girls to sleep-away camp. There had definitely been apprehension mounting in the preceding weeks, and procrastination from me, as this was a new adventure for all of us.

We set out on our 10.5-hour car ride to Arlington, Wash. I kept reinforcing how much fun this was going to be. I even suggested that I could stay at camp while they returned home. I wondered if I was looking forward to it more than they were.

We had to be at camp between 9 and 11 a.m. We chose to be there around 9:30 a.m., so they could feel comfortable that there were other children there and that they weren’t the only ones.

As we pulled into camp, we were greeted by two young women. We rolled down the window and they greeted us, saying, “You three must be Sarah, Rachel, and Leah.” We were impressed that out of 100 children expected, they were able to identify my three kids.

As we parked, we were approached by other counselors and support staff. They introduced themselves and said, “You must be Sarah, Rachel, and Leah. We have been expecting you.” As they loaded the girls’ gear to transport, they started speaking to my oldest, saying, “There are so many unique song birds here” and, “There is a volleyball game later in the afternoon.” As we walked to various registration stations, we were warmly greeted, and each staff person knew a bit more about my kids.

My 8-year-old had been the most skeptical. As we approached her bunk, she was amazed to find that she would be right across from her older sister. By this time, my kids had all but forgotten about leaving home and being at camp for the next two weeks. And I was so pleased with how comfortable they had made my kids feel that it got me to thinking how the camp experience parallels what we are faced with in health care every day.

We treat thousands of people every year, each an individual with a story to tell, a very important story, some fascinating, some heart-wrenching.

This is what makes the relationship between a patient and a physician so valuable. What if we could enhance this experience in a way analogous to the experience my kids had at camp? How can we make the overall experience a comforting one?

I feel that it all starts with a relationship. Understanding who our patients are, their values, and their story all create a “sticky” ecosystem.

Approaching and navigating a healthcare system is daunting, and can be intimidating at times. I have had personal experience of trying to navigate the system. I would say that I am rather well-versed in how the system works, but all that knowledge goes out the window when you or your loved one is ill.

This is where I feel we need to transform. We know our own community, we live in our community, and we treat our teachers and our neighbors. We pride ourselves in being an integral part of the communities we serve.

You may now be wondering why I’m talking about relationships. As a physician and Chief Information Officer, I can appreciate the way technology can improve the way we engage with our community.

As a country we have come a long way.  We have moved past the trough of disillusionment and are on our way toward digitizing our industry.  While we have installed advanced clinical technology we are just starting to see the way we need to integrate and facilitate the movement of data to improve the patient care experience.

The word integrated is very important. In order to build and maintain a fruitful relationship, we need to earn the trust in the care the community entrusts with us. Part of that trust is that we provide clinicians with the most timely information at the most appropriate time.

This integration is a key component to high-quality, efficient health care. This essentially completes the circle (the continuum) of care.  While we have a long way to go we have a path and a plan and I truly believe our patients will benefit from this heavy lifting.  We are in fact transforming a culture.

If you live in East Lansing, Michigan and happen to be visiting family in Savannah, Georgia and you get sick, the physician you see will have complete access to your entire medical record, not a faxed copy.  This is the direction we need to go.  Our mutual patients need to feel just safe anywhere they seek care.

Our patients are slowly demanding this. Medicine and the delivery of care is becoming consumerized.  Some my look at this as the end of the physician patient relationship while I look at it as the best opportunity to truly engage patients in their care.  No other time in the history of modernized medicine has the patient takes such an interest in their own care.  As an industry we would be foolish not to take advantage of this opportunity.

Two weeks later, when I returned to pick up the girls, I sought out the camp director to better understand his system. As it turns out, he asks multiple short questions throughout the year, slowly building out his information on each child (favorite colors, interests, struggles, etc.) for a shared application that the staff reviews prior to camp. Each staff member has a familiarity with each child and can call upon the data to help make the transition as safe and comfortable as possible.

I feel we owe it to our patients and the country provide as comprehensive a care document as possible so we can achieve the triple aim of better health, better care at a lower cost.