Electronic Health Records

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Pushing through the gaps in health information exchange

By Kyle Murphy, PhD

Even in well-connected areas of the United States, the flow of health information between providers is not a straightforward process if one at all. Although integrated delivery networks (IDNs) have increased their capabilities for sharing patient data among their own providers, their ability to access information on new patients, especially in emergency situations, lags behind.

“Every one of the CMIOs or CMOs in this city is a dear friend of mine — people I see every day or may have dinner with on a Friday night — but yet our organizations do not speak to each other,” says Nicholas Desai, MD, DPM, MBA, CMIO of Houston Methodist Health System. “It’s not that we’re not friendly — it’s just that the nature of theses organization have historically been siloed entities.”

The lasting effects of this isolated approach prove problematic as healthcare trends toward greater and greater mobility for patient populations and how the latter access care.

“Healthcare has evolved and people bounce from hospital to hospital, and it’s important for us to be able to have information at the fingertips of our providers as they deliver care at the point of care,” Desai explains. “Even having a few text documents, it is significantly more important to get contextual support for what you need to do for this patient right then and there.”

Desai and other leadership at the physician-led health system in Houston have spent a considerable time recently looking for ways to ensure that patient health information is available to providers where and when it is most effective — at the point of care.

As the Houston Methodist Health System continues to grow and add additional hospitals and physician networks to its organization, the challenge of integrating health IT has become more complex. Health information exchange (HIE) provides a mechanism for handling this added complexity.

“As a provider, having information at your fingerprints is probably the most important piece and which most people take for granted,” Desai maintains. “Having information is really critical to going from being a good doctor to a phenomenal one — to be able to be that sleuth and figure out what you need.”

The Houston health system has worked with the Greater Houston Healthconnect to give its providers access to accurate and timely data. “As we onboard more hospitals that are from different providers, we’ve gone from one IDN to another. Bridging the gap is hard but keeping the base philosophies — how do we continue to evolve our integration and interfacing within our applications — is the simplest way,” adds Desai.

According to the Houston CMIO, HIE still has a long way to go in order to be truly meaningful to providers. “It’s a two-part process and we’re learning from it. Part one is unfortunately going to be a very archaic way,” continues Desai, “that is, in most organizations you’re going to have your EMRs or EHRs and dealing with interfacing an HIE piece into them.”

That is the pull phase of HIE. It is well short of where Desai and others ultimately see HIE going and having the most value. “The Holy Grail is where the computing occurs on the backend and retrieves for you as you’re in the moment. That’s what we’re headed for,” he adds.

The Houston Methodist Health System is in the process of migrating their current health IT systems to Epic Systems with one of the main goals being able to push information to providers.

“We want to be essentially a push,” says Desai. “It’s not pull anymore. It’s there for you at your fingertips. We’re continuing to find patches to do that right now to simulate that until we get into our new environment.”

While the most compelling use cases for HIE currently are in emergency situations, the ability to exchange information can have a more far-reaching impact on all providers. The challenge is implementing health IT systems capable of pushing information between different settings, especially those out of network.




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