Category Archives: Rules of the Road

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.

 

 

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.

 

Seamless Transfer of Information

As I stated in my last post I have been deeply involved with establishing a “Rules of the Road” for the interoperability of patients health information.  I truly believe that in order to aspire toward the triple aim of better health, better care at a lower cost we must provide the most accurate, most timely information for the clinician to make a well informed decision. Only then will be truly understand the cost of care and drive to prevent redundant testing and render care in the most appropriate venue. With that in mind I had the pleasure of sitting down for an interview with Roya Camp of St. Luke’s Health System to discuss my involvement in this national initiative of improving the access of timely health information- interoperability.