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How Inbound Data Changes Health IT Interoperability Strategy

"It comes down to setting up the process and technology that’s required to route information logically."

By Frank Irving

- How much does interoperability factor into IT design strategy at healthcare organizations? Not enough, according to the American Medical Association (AMA), which spent part of its Interim Meeting in November advocating for more interoperable electronic health records.

Inbound data is starting to change the discussion of health IT interoperability and design strategy at provider organizations.

In fact, the AMA’s position is that EHR vendors’ systems should be required to comply with interoperability standards before being certified for use in the federal meaningful use program. And the nation’s largest physician group wants “universal and enforceable” EHR standards to be in place before the Merit-Based Incentive Payment System for Medicare physicians is implemented in 2019.

Whether those calls to action will be heeded remains to be seen; however, ambulatory care practices and clinics may be starting to realize benefits from meaningful use in terms of interoperability — beyond merely meeting requirements and avoiding reimbursement penalties.

That’s the view of Vikram Sheshadri, vice president of product development at healthcare technology consultancy eMedApps, who agreed to a recent interview with HealthITInteroperability. Here’s what he’s hearing from the field in regard to healthcare data interoperability and integration.

HealthITInteroperability (HITI): What are practices and clinics in the ambulatory space doing with meaningful use that would get them more deeply involved in interoperability discussions?

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Vikram Sheshadri (VS): Many people went into meaningful use with an idea of meeting the measures. They said, “I’ve got to get 10 percent of my referrals, and I need to do X percentage of other things and communicate that data out.” When you are only the producer of data, it’s hard to see what you get out of the process. What do I get from a clinical perspective? How does sending out data help my patient?

But one of the side effects from the process was that they really started to see information coming in. Suddenly information was making its way to the provider. One of the pleasant surprises was when pharmacies found providers’ Direct addresses and began sending them information on patient immunizations at the pharmacies. That’s where providers started to see the true benefit of interoperability. The light bulb went on in their heads: “Wait a minute; this is good.”

HITI: But now providers have to figure out what to do with that information, correct?

VS: Yes, it sparked a discussion in these organizations about how to deal with the incoming data that’s now becoming more of a reality. Functionality- and technology-wise, it has been available to provider organizations in terms of querying a local health information exchange and getting data on a patient. But that really hasn’t made its way into the clinics, community health centers and multi-specialty groups. It had been happening more in the large hospital systems.

With the expansion of Direct Messaging, however, the focus is shifting. From both a technology and process perspective, provider organizations are thinking about how they’ll deal with information coming in from outside sources — whether those sources are other providers sending C-CDAs for transfers of care, or the CVSs and Walgreens of the world sending immunization updates to the providers’ offices.

We’re even starting to talk about patient-generated data. The idea of importing data from a wearable device is not so far-fetched and has entered the discussion for some provider organizations.

HITI: What approaches could providers take to handle the influx of data?

VS: Think about how the roles within care delivery organizations will change and where the information will be going. Will it get imported into the EHR? If so, what is the process for doing that? They need to consider how to set things up without placing all of the burden on the physicians. That’s a surefire way to decrease acceptance of the incoming data.

It comes down to setting up the process and technology that’s required to route information logically. It requires decisions like “This kind of document really doesn’t need to route to the physician; it can go to ancillary clinical staff.” In another scenario, you may need to import the clinical information from a transfer-of-care document and then route it to the physician prior to the consult or patient visit.

One of the things we’ve been doing is to introduce technology once that CCD gets to the clinic. We’re going to pick it up and allow the organization to create routing logic and rules. Based on the originator or type of CCD, the message will be processed in a certain way. There will be certain notifications and approvals associated with the order so that providers and staff can route that inbound message to the right channels and maximize clinical efficiency and workflow. That sort of routing technology will be very important in the inbound space.

HITI: Are there potential challenges standing in the way of moving in this direction?

VS: A large component of concern that we’ve seen has been around patient privacy, and the variation from state to state in terms of privacy regulations. For example, state law may prohibit sharing data on a patient who has HIV. In that case, you need to have a workflow to make sure that data will not be transferred out. And if your EHR doesn’t readily support that process, you’ll have to be able to come up with workarounds — and still stay in compliance with meaningful use and regulatory requirements.

There’s a bit of a lag on the regulatory side behind the technology in terms of dealing with these types of consent-related issues, but it’s an important discussion point. We’ve seen it as a red flag in a lot of organizations.

Some organizations are also worried about the acquisition cost for this technology.

And there’s the concern about actually implementing the technology. What will be the effect on workflow after putting this functionality in? If the motivation to achieve interoperability is merely for meaningful use, there may be resistance because of changes to workflow and modifications to provider and clinical staff routines in order to be compliant.

It all ties back to the beginning of our discussion: The ability of users to see the benefit of what they are doing ultimately will help drive adoption. My hope is that we get to the point where we achieve the interoperability goals that were set out in the meaningful use process from the start.




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