At Mercy Health, one of our most important goals is keeping patients safer by allowing critical information to move with them – whether they’re traveling to an institution like the Mayo Clinic for treatment or seeking emergency care while away from home. The importance of exchanging records seamlessly, and the added value of providing better care for patients, cannot be overstated. Indeed, I’m continuously amazed by just how much information exists relative to how providers are exchanging records and sharing information between and among disparate systems.
For several years we’ve used Care Everywhere from Epic to ensure that all patients receive care that is based on the right data available to the right provider, at the right time. By making patient information accessible across the continuum of care — in the emergency department or surgery center or when seeing a physician outside their regular health system or in another state — we can ensure it follows patients wherever life takes them. We’ve even gone a step further and implemented Advance Record Location, a system that helps locate patient records without a manual search by the provider.
The Straightforward Exchange.
Our data exchange program has allowed us to exchange records with clinicians within Mercy Health and with:
∙ Organizations using electronic health records (EHRs) from other vendors
∙ Health Information Service Providers (HISPs)
∙ Health Information Exchanges (HIEs)
∙ Organizations on the eHealth Exchange
∙ Government entities such as the Department of Veterans Affairs, the Social Security Administration, and the Department of Defense
Through interactions with our top exchange partners in 2015 – UC Health, TriHealth, The Christ Hospital, Cleveland Clinic, and Cincinnati Children’s Hospital and Medical Center – Mercy Health exchanged almost 2.5 millions records in the first four months of 2015 alone. Since our go-live with Care Everywhere in 2012, we’ve exchanged more than 10 million patient records with 234 other organizations across 48 states.
Crossing the threshold of 10 million patient record exchanges is a feat driven in part by improvements in our government connections. For example, since beginning data exchange with the Social Security Administration (SSA) in January 2015, we’ve had 8,871 successful transactions, with an 82 percent match rate. We connected with the Veterans Administration (VA) in March 2015 and are also in the process of connecting with the Department of Defense (DoD).
The exchange of patient data through the SSA is fairly straightforward. When a patient files for disability she has to sign to have a record released. In the past, we did this on paper, but with the system we now have in place the process is automated, eliminating the need for physician and staff intervention. Once a patient gives consent to SSA, we receive the request electronically and our system can automatically see if it matches a patient. If there’s a match, the summary of care document is sent directly back to the SSA. Everyone wins.
There’s no chance for mistakes that may have occurred in the past during the course of translation errors with paper faxes. With one click, our clinicians know they have access to a powerful tool that helps auto-query information too. For instance, we run automatic queries within a 100-mile radius of where a patient is located and cross-check against other partners with whom we exchange information to see if there are new records to exchange.
The goal is to break down barriers, decrease the need for additional consultations and testing, and increase the ability to make the process more seamless and easier on the patient. Patients don’t have to remember when a particular test result or doctor’s visit took place and staff doesn’t have to worry about searching through paper charts to transfer necessary data.
The Benefits of Exchanging Discrete Data.
Having a consensual agreement in place for the shared exchange of data has other benefits too. The great thing about working with other Epic Partners is that we can exchange discrete information in three areas:
1. Problem list
2. Medications
3. Allergies
If a patient goes to an organization’s ED and then follows up at one of our sites for primary care, we can see what care was provided. If it was a new condition, it can be added to the problem list, medication or allergy notes without having to re-enter information into a chart, all with a single click.
How significant would it be, as we continue to exchange information discretely, to pass this data along from one community to another, one care setting to another? Wouldn’t it help providers and patients if they did not have to repeatedly ask and answer the same questions? Won’t it be easier to say, “I see you are allergic to Penicillin. Any new allergies I should know about?”
Let’s take the guesswork out of the equation. It’s not always easy for a patient to remember what year he had knee surgery, but some day in the not-so-distant future we won’t have to ask that question because we shared the information at some other point of the care delivery process. It will already be baked into our workflow.
To be clear, I’m talking about shared medical information, not a nationwide medical record or data repository that would be queried. I’m referring to exchanging information from site to site, in a way that operates more as a Web query than a data repository.
A more seamless exchange of patient data is one area of care where we can do better as a society, and we will as we work to improve on truly standardizing the way we automatically exchange data behind the scenes. It’s not unlike how we used to do things in the paper world, where we would segregate outside records into a separate section of the chart. Now we can electronically view a summary and conduct an additional query to obtain further detail regarding discrete data points.
Successes and Struggles.
Our success goes beyond records exchange with Epic. We started our first non-Epic patient record exchange community with Greenway in February 2014. While we can’t yet exchange the same discrete data like we can with other Epic clients, we can perform similar types of queries so that, for example, an OB with privileges at our hospital can access her patient’s prenatal and OB records and have a complete record of care at her fingertips.
In general, our biggest struggle has been with the vendors who can’t exchange the information we need using the latest standards because their systems don’t “talk” to ours the way they need to. We’ve had some of these discussions around the how’s and why’s of it with other vendors who have struggled to keep up with the latest in data exchange and we are hopeful progress can be made. The cool thing is that once infrastructure is set on both sides, one connection should (in theory) equal one connection so it’s simple to connect each office within an organization.
Rules-Based Actionable Clinical Decision Support (CDS) is one logical next step in driving this evidence-based care even deeper into the workflow, helping to minimize re-work and unnecessary steps for clinicians. When we can consistently provide a framework for interoperability, so wherever the patient goes the clinicians providing care can have the information they need, the process will improve.
Actionable CDS can take advantage of rules-based, patient-specific CDS and present the most current medical evidence based on a specific patient’s age, weight, current medical conditions, known allergies, medications, and a host of other data points available to a patient surveillance engine. It can run complex, evidence-based rules to deliver patient-specific advice to the physician or nurse at the point of care. Information can come from another Epic system, a non-Epic EMR that complies with industry standards, or directly from the patient. When the process works on both sides of an exchange, we can allow for the transfer of richer data sets and additional connectivity options, such as cross-organization referral management.
The greatest challenge lies in understanding the importance, while acknowledging the difficulty, in vendors remaining current with the latest standards and the ability to work with and exchange information seamlessly across EMR platforms. One question that comes up is whether or not we should be using HIEs to accomplish this task. My personal opinion is that we shouldn’t need this in the future state. Vendors should be committed to connecting to one another to create this seamless web of connected and interconnected electronic records that doesn’t require a data exchange to pull what’s necessary.
Regardless of the information source, it’s important to give clinicians a more complete clinical record. I’m amazed at how enthusiastically Mercy Health’s providers and patients have embraced our data exchange. When will the healthcare industry take a page from banking and travel? This should be the here and now.
Stephen Beck, MD, FACP, FHIMSS, currently serves as Chief Medical Informatics Officer at Mercy Health (www.mercy.com). He has nearly 20 years of experience in planning, implementation, training and follow-up of EHR installations in civilian and military populations and was one of the first physician users of a fully integrated EHR in Southern Ohio. He is a Fellow of both HIMSS and the American College of Physicians and serves on the HIMSS Quality, Cost and Safety Committee. Email him at srbeck@mercy.com or follow him on Twitter (@StephenBeckMD).
