How Indian River Medical Center is Dealing with the Lack of Electronic Health Record Interoperability

Medial CenterA NEW REPERT BY THE GOVERNMENT ACCOUNTABILITY OFFICE (GAO) says that despite efforts to streamline the methods and reduce the costs of sharing patient information through electronic health records; after interviewing stakeholders in four states GAO found that “data fragmentation …costs the beleaguered healthcare system up to $ 2 hundred 26 billion per year.” (Source: GAO – Lack of Standards Foils EHR Interoperability)

The Office of the National Coordinator for Health Information (ONC) “is the principal federal entity charged with coordination nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information.”
Source: website) According to ONC there are 2098 modular and complete EHR systems for ambulatory and inpatient care.

ONC has published a draft version of its 10 year interoperability roadmap that includes the short-term goal of taking actions that “will enable a majority across the care continuum to send, receive, find and use a common set of clinical information on a nationwide level by the end of 2017.”

Meanwhile, there are are a crowd of other EHR vendors, Governmental agencies and not-for profit collaboratives and Health Information Exchange systems scrambling to establish standards for EHR system integration and interoperability. A new industry of systems integrators has been created to develop software “middleware” between systems.

William Neil, VP/Chief Information Officer at the Indian River Medical Center (IRMC), was kind enough to share his thoughts on how IRMC is operating in this environment.

At the outset, Mr. Neil emphasized that EHR interoperability is an “industry challenge. There is not a clear Strategy, Definition, Data Standard, or Functional Use Standard for interoperability.”

From our discussions and emails it is hard to believe he has time to go home at night. Every day he has a scheduled one-hour 4:00 conference call with RelayHealth (a McKesson product allowing for connectivity and interoperability) and e-ClinicalWorks, another EHR systems vendor. This is just one of his conference calls as he bounces from one to another.

One of EHR interoperability challenges is referred to as a “Naming Convention,” which is how people standardize inputting data. Mr. Neil says, “am I William Neil, Bill Neil or Neil, Bill?” What about a middle initial or if he is a Jr. or III? Or if you have a hyphenated name. Or the EHR system you are trying to operate with doesn’t have the field length to support a hyphenated name? The challenge here is to ensure you are dealing with the right patient.

Mr. Neil indicated IRMC has taken the “Health Information Exchange (HIE)” approach to interoperability, utilizing RelayHealth, referred to above. RelayHealth allows IRMC to connect with HealthSouth who uses a Cerner EHR system as well as to e-ClinicalWorks for lab orders and results.

A HIE allows for sending and receiving clinical data in ways the information can be understood by multiple EHR systems. Data can be “Pushed,” to another EHR, such as a non-healthcare example of sending an email, or “pulled,” such as making a query (e.g. cardiac condition) and getting a response. A non-health example would be a google search. (Source: Minnesota eHealth – July 2013)

An alternative to utilizing a HIE is an HL7 interface, a program that works in the background to integrate data. HL7 (High Level Seven), is a not-for-profit standards developing organization providing for the exchange, integration, sharing and retrieval of electronic health information. On December 7, 2014, HL7 launched Argonaut, a project to advance Fast Healthcare Interoperability Resources (FHIR), a standard for exchanging healthcare information electronically.

IRMC also uses Clinical Data Architecture (CDA) records for the exchange of true patient health records to its RelayHealth Platform. CDA is a “mark-up” standard developed by HL7 to define the structure of clinical documents such as discharge summaries and progress notes. This document can include text, images and different types of multimedia. (Source: TechTarget – posted by Margaret Rouse)

According to Wikipedia, “a mark-up language is a modern system for annotating a document that is syntactically distinguishable from the text.”

If you are still reading, is this TMI (too much information)? Do you think Mr. Neil and his staff have enough on their plate?

We have two more subjects to cover.

IRMC utilizes a RelayHealth “Patient Portal” tool to engage patients in their healthcare. When a patient is discharged they are given the opportunity to sign up for a patient portal that is a mobile software tool that allows them complete access to their medical records, such as laboratory results, as well to schedule appointments and pay bills. If a Vero Beach IRMC patient is in Falmouth, Massachusetts for the summer and needs to go to Falmouth Hospital, which uses a different EHR system, they can provide the hospital with their patient portal to share their records and have them integrated into the Falmouth. Otherwise, had they not signed up for the portal, Falmouth would have to request the data from IRMC, it would be time-consuming and most of the data would arrive by fax.

Additionally, according Mr. Neil, existing legislation and the Stark Law, which prohibits physicians from to referring patients to entities with whom they have a financial interest, “makes it difficult for organizations like IRMC to work with its 200 plus community physicians for interoperability to their EHRs. In order to avoid the misconception of providing provider to one physician who may currently refer patients to IRMC and not to others…we have taken the stance (error on the side of caution) to…have a standard interface with RelayHealth that all practices must adhere to.”

This was a highly technical exercise, but will at least give you a sense of what goes on in the IRMC IT department. If we have written any thing in error please advise.

One last consideration, is that according to an Experian report, the 2014 Data Breach Industry Forecast, “Healthcare will be a hotbed of consumer data breaches in 2014.”

According to Michael Bruemmor, VP of Experian’s Breach Resolution Service, “many participants in the healthcare industry, such as individual doctor’s offices, don’t think of themselves as being in the data management business, so they are inadequately prepared to protect data against threats that exist today. In most cases, data breaches have less to do with advanced hacking techniques than with lost laptops, failing to shred paper records, and other employee errors. Though the threat from malicious insiders is significant, a bigger threat is people doing dumb things.”

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