Joel Diamond, MD, CMO, Allscripts dbMotion Solution
Health information exchange” has found a permanent home within our industry’s lexicon—and justifiably so.
A generation ago, health information exchange simply described what happened when two physicians discussed a patient’s condition and prognosis by phone or in a hospital hallway. Now, it symbolizes a systemized, professional standard of care requiring new technologies and workflows. In reality, the concept and idea of “health information exchange” needs further refinement.
Central to that objective is clarifying the difference between Health Information Exchange (the noun), and health information exchange (the verb).
Only Effective Health Information Exchange can Drive HIE Success
The number of Health Information Exchanges or HIEs—as independent entities—has grown rapidly in recent years. They span both the public (e.g., state-wide organizations) and the private sectors (e.g., ClinicalConnect HIE in western Pennsylvania). Their intent is noble: to help providers and the care team communicate, coordinate and collaborate to improve patient outcomes and reduce unnecessary costs.
But, in truth, this can’t happen without effective health information exchange—the verb. The industry must focus its attention on making sure clinicians have access to relevant and comprehensive patient information at the point of care— information that is meaningful and can be acted upon in order to have an immediate impact on clinical decision making, as well as the development and execution of an effective care plan.
"The industry must focus its attention on making sure clinicians have access to relevant and comprehensive patient information at the point of care”
So, how can focusing on the verb help the noun be more successful? HIEs must make sure they accomplish health information exchange that renders critical data:
1. Accessible: Data that affects patient care—history, lab results, medications, procedures, allergies, care plans, chronic conditions and more—must be available to providers when and where they need it. Clinicians are notorious for their resistance to clicking in and out of applications, or opening and closing multiple windows and documents. Health information exchange must occur in real time, at the point of care, within the clinician’s native workflow.
2. Understandable: Along the same lines, providers and other care givers must be able to understand both the detail and the significance of the data being presented to them. It must be semantically harmonized, for one thing, so that all of the vocabularies and formats imposed by various source clinical information systems are standardized according to the provider’s preference. And, it must be organized so the clinician is not forced to hunt and peck, sort and categorize, or prioritize and eliminate. To the point made in #1, busy providers have neither the time nor the inclination to make sense of a pandemonium of data.
3. Reliable: Clinicians must be able to trust the information they reference when diagnosing and treating a patient. They need to know they have the complete picture, a comprehensive view of that patient’s status and conditions. Only with all relevant information can they be reasonably sure of delivering optimal care.
4. Actionable: In a way, the three previous points roll up into the fourth. Only if providers have access to timely, understandable and reliable patient information can they feel confident acting upon it. If that data is presented to them within their preferred workflow—or even integrated directly into their native EHR—they can act in a timely and impactful manner.
Information Exchange Among the Right Entities
Another important question we need to ask ourselves when examining effective health information exchange—and, thereby, successful HIEs—are:
Are we connecting the right entities?
When HIEs first gained a toehold in the healthcare industry, it was natural to organize them around state lines. And, for some functions such as disease and immunization registries, that still makes sense.
But, for effective care delivery, we must think outside of the geographic box. Consider New York State, for example. Patients (and their providers) in the New York City metro area may benefit more from health information exchange that bridges New York, Connecticut and New Jersey because it’s conceivable that care may be delivered across these various geographies. Residents of Buffalo, however, likely have less need for their health data to be easily available to a physician in Manhattan than a resident of Newark might.
As the trend towards establishing HIEs continue—and it should—we must nevertheless make sure the movement of health information follows the same pathways as patients seeking care.
A case in point is the ClinicalConnect HIE in western Pennsylvania, referenced above. It creates a network among 12 community health systems in rural areas of the state to enable health information exchange—and likewise connects them to UPMC in Pittsburgh where patients can go for specialty care. In any setting, clinicians have access to patients’ complete, up-to-date medical record, made available through the Allscripts dbMotion interoperability solution.
In short, HIEs play an important role in health care today. We can ensure their continued success and increased relevance by ensuring that active, robust health information exchange remains a top priority.