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The Real Way to Talk About Interoperability

by John Voith, Director of Transaction Services

In an earlier post about interoperability, I highlighted the wide range of technical standards that exist, HL7, DICOM, ISO, IHE, and so on. The health care industry sometimes gets hung up on the standards and doesn’t focus on what really matters: enabling providers and patients to complete particular "jobs" through interoperability. Among those jobs, the most important is sharing patient charts between providers, regardless of location, for the purposes of improving patient care.

The value of this functionality is universally understood. The government even initiated the Meaningful Use program to promote and incentivize interoperability (among other things) and has paid out over $25 billion to date in incentive payments. And still, EHRs are not adequately “interoperable."

Let’s not despair. Instead, I’d like to bring some hope and optimism to the subject, offering providers and patients some background on the complexities of patient chart sharing and an approach to solving this interoperability problem.

First, consider the two simple elements of a chart-sharing exchange: 1) The need to “push” chart information, and 2) the need to “pull” it. There are many technical standards that support each.

  1. Push: Let’s assume I’m a patient and my primary care provider wants to refer me to a specialist. How does he or she share my chart? Fax is one option – an outdated, generally inefficient option, that’s all-too frequently used today. However, the PCP could also enter the 21st century and push data to the specialist via electronic options such as DIRECT, “cloud-to-cloud”, or IHE profiles.
  2. a. DIRECT is an information delivery standard required by Meaningful Use Stage 2 – think of it like email, but with more security layers between companies that provide DIRECT addresses. All athenaClinicals EHR clients have DIRECT addresses, the ability to send outbound DIRECT messages, and the ability to view inbound DIRECT messages.

    b. “Cloud-to-cloud” is the ability to push chart information between providers as athenahealth clients do.  It’s simple: Because we are cloud-based, on a single network, we can accomplish this without needing interfaces or government-approved technical standards. This is not the case with traditional software vendors.

    c. IHE (Integrating the Healthcare Enterprise) profiles (i.e. XDS.b, PIX, PDQ) are used to establish “point to point” connections with software vendors and/or health information exchanges that do not support DIRECT.

  3. Pull: Okay, now let’s say I’m traveling with my family and need to visit an urgent care clinic. The physician or nurse practitioner there can access my electronic medical record through a couple different means.
  4. a. The CommonWell Health Alliance, a collection of provider organizations and service providers, uses a common set of standards that allow EHR vendor members to pull data from one another. At athenahealth, CommonWell is integrated directly into our EHR service, enabling our providers to easily pull data from any other provider connected to CommonWell (assuming proper patient consent).

    b. IHE profiles are used to establish “point-to-point” connections with software vendors and/or Health Information Exchanges who are not part of CommonWell.

Regardless of the interoperability need, athenahealth supports a number of standards that fulfill both the “push” and the “pull,” with options that are free of charge. We aim to match the appropriate standard to the appropriate situation, to help our clients accomplish their goal without having to contend with a jigsaw puzzle of standards.

Here’s the key: This is the health IT service provider’s responsibility.

When athenahealth clients need to push clinical chart data, they can do so within the physicians’ clinical workflows, right at the point of ordering. Which standard will best accomplish a particular need? That’s for us to recommend and make work, behind the scenes wherever possible and appropriate, keeping quality of patient care at the center of our approach. There should be very limited responsibility placed on the health care providers and the technical standard should not affect clinical workflows.

When our clients need to pull clinical chart data, the ability to do so is also built into their clinical workflows; in fact, a provider can pull clinical information from a patient’s chart in another care setting without having to navigate additional screens in our EHR.

While the industry is still in the early stages of enabling this type of chart sharing, we believe we should take on the burden of making this work for clients. athenahealth providers can pull information from EHRs nationally, and we also create national or global integrations whenever we can.

One of the biggest challenges we face in health care is making interoperability as easy as possible for providers and patients – this means reducing barriers by alleviating the need for providers to navigate complex technical standards and reducing fees for interoperability wherever possible. No one ever went to medical school to become experts at interoperability technical standards. Each health care provider should be allowed to focus on the “job” they want accomplished, to deliver quality patient care while aiming toward desired business results. High-effort, high-cost interoperability simply cannot get in the way.

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Comments

Submitted by Sapna Kapoor - Thursday, July 2, 2015

Thnks for sharing this valuable information with us... i digg this info...

Submitted by William Dempsey MD - Friday, April 24, 2015

Recently changed employers. Both use medent emr. When I asked that my patients records be transferred I was told that would cost $4000. I refused which resulted in my patients being cared for without their records. Practices such as this are reprehensible and have resulted in the current disdain towards EMR companies who in most situations are more concerned about lining their own pockets than patient care.

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