Picture this. It’s 3am. A patient comes into your ER unconscious after a car accident just down the road. The patient has never been in your facility before so you don’t know the status of their medications, allergies, or any medical history. I think we can all agree, this makes it challenging to provide the safest, most accurate care.
But what if there was a way to share vital medical patient information electronically between other local healthcare facilities where the unconscious patient has been before? Not only would that be a great idea, it’s something we’ve already done.
Over the past few years, Salinas Valley Memorial Healthcare System (SVMHS), Montage Health, and Natividad Medical Center, worked to create and implement a county-wide Health Information Exchange (HIE). The results of this collaborative effort is an entity we named Central Coast Health Connect.
It turns out that sharing data was not overly difficult from a technical perspective. Each hospital was already distributing data internally between systems. Our struggles ended up pertaining more to the legality, governance, and compliance of this project. Interoperability was achieved with existing interface standards that have been around forever.
Collaboration and Competition
The three entities that worked to form the HIE are organizations independent from one another, each with their own governance. Since we all serve the same geographic patient population, we are also competitors. Many of the patients in our area have had visits at two or even all three hospitals, each with their own medical record. Having this shared system that aggregates records from multiple sources allows all of the participating facilities to better serve our patients.
It is one thing to be able to share data, but quite another to do it in a way that is compliant with privacy laws, well managed, highly secure, and done in a way everyone can agree to. A legal framework had to be developed in order to facilitate participation agreements, ensure privacy safeguards, facilitate access, and perform auditing. Legal issues had to be addressed via controls and safeguards due to variations in state and federal law. Ultimately we wanted a system where it was easy to share data, but still restricted to those who were actually treating the patient.
Going into the project, it was assumed that the technical barriers would take the most time to navigate through. In reality, within several months we were finished with building and testing the technical components required to populate the HIE. The data was kept in isolation for each facility until the agreements and framework could be completed, which took well over another year. The agreements had to be adopted by each of the three organizations as well as hundreds of physicians in order to participate.
Currently, our HIE is populated with data sent from three hospitals and over 40 clinics, urgent care, primary care, and specialty care locations. Additionally, there are a number of providers and clinics that only receive data from the HIE. Two of the three hospitals utilize MEDITECH, and throughout all the contributing facilities there are a total of eight different EHR vendors.
While certainly the HIE is an IT system, it took the efforts of clinicians, executives, privacy officers, lawyers, and analysts to bring it about. All of these efforts culminated with the linking and sharing of records across facilities in the summer of 2016.
Benefits of our HIE
There are three functional components included in our HIE:
- A consolidated medical record from sources across the county
- Results and report distribution to providers
- A patient portal and a provider portal
These components all serve to improve patient outcomes. A consolidated patient record and provider portal allow our ER physicians to see a snapshot of a patient’s health and the summary of each hospital or practice visit. Additionally, most of the patient’s lab, imaging, and medical record reports are sent into the portal as well. Previously, this information generally wasn’t available in the middle of the night during an ER visit. This can be especially helpful for patients with a complex medical history.
Results distribution provides lab, imaging, and other results directly back to the ordering physician’s EHR. This removes the need for staff to manually enter or scan results into the practice, essentially making them instantly available in the chart at the doctor’s office. While this was something that was done prior to the HIE, the HIE allowed us to reduce the number of interfaces needed for each practice.
Finally, a consolidated patient portal gives the patient easy access to their data in order to better manage their health. While portals have become common in the last few years, every facility tends to have its own. This means patients need to manage multiple accounts with multiple providers, which is frustrating and can hinder utilization.
The technology platform for our HIE utilizes RelayHealth, which provides the system and services for all three components. Each of the hospitals provide clinical and demographic data via HL7 and C-CDA data feeds, providing the system with results from lab, imaging, medical records, as well as a snapshot from each visit with data such as medications, allergies, procedures, problems, vitals, immunizations and so forth. Many of the prerequisite technical pieces were all in place in the hospitals due to the CMS requirements for the Meaningful Use program. It was just a matter of putting the technology to productive use.
What’s Next?
We are working to bring more automatically embedded HIE data into the patient chart. This will reduce the need for clinicians to spend time in two different applications. Every extra step that is required to get to the data within the HIE reduces its usage. If the process can become nearly seamless, it will greatly reduce the barriers to HIE adoption. Most of our current efforts are focused on educating and training since there is only value to the system if it is used. We believe our HIE is a great example of what can be achieved through collaborative efforts, and are looking forward to its continued development in the future.
Learn more about MEDITECH’s EHR interoperability offerings and how they align with industry movement, both present and future.
