Fixes for Health Information Exchange

Health information exchange technology is at a bit of a crossroads, according to Will Ross, project manager at Redwood MedNet, a not-for-profit based in Lake and Mendocino counties aimed at accelerating adoption of health information technology in rural Northern California.

Ross was one of the organizers of the annual Redwood MedNet conference Connecting California to Improve Patient Care in 2015 Friday in Santa Rosa. 

“There was a lot of reality check to the event,” Ross said. “The bad news is that the technology isn’t great, and the good news is that we have a plan to make it better.”

Health information exchange is a secure data service using national standards to enable the electronic transfer of clinical information among health care facilities.

As a sort of road map to how to fix the health information exchange system in California, Ross pointed to one of the presentations at the conference, based on a report in the Journal of the American Medical Informatics Association which laid out 10 recommendations for what needs to happen in HIE, Ross said.

Recommendations included simplifying and speeding up data entry for clinicians so EHR systems are more usable and making sure EHRs are used as a learning resource rather than as a billing mechanism.

“That’s at the heart of what we’re trying to accomplish,” Ross said. “The electronic health records have serious problems and we have to address them.”

“EHRs continue to be based on claims and reimbursement,” Ross said. “They’re used to quickly create billing claims.” What that means, Ross said, is that providers spend a lot of time entering treatment data into the computer during an office visit and not actually spending time looking at and talking to the patient.

“This is compromising clinical quality because they’re using it as a billing tool, rather than a primary clinical investigation tool for the patient,” Ross said.

The first step, Ross said, “is to find standards everyone agrees on.” That’s easier said than done because of the money being made on proprietary software, he said.

“We need to build standards right and have everything be transparent,” Ross said, “rather than hidden behind proprietary walls.”

Ross said meaningful use specifications are inadequate and weak. Right now, he said, if everything in HIE worked the way it should and providers could access a patient’s full medical record from all of the different clinical settings (hospital, emergency department, clinic, laboratory, pharmacy, etc.), that information still needs to be available in some kind of summary form.

For instance, if a clinician wants to know about the oncology history of a patient, that should be immediately accessible in concise form. Right now, he said, the provider would need to read the entire medical record before every office visit to get necessary information.

“If you use the current tools and query a patient for records and the HIE thing works great, it brings you 60 visits over the last year — so what are you going to look at?” Ross said. “We need the information we want, and the summary is usually what you want. You don’t want the whole record, that’s like having a phone book come back to you.”

The data clinicians need should bubble to the surface, Ross said, which means a new approach to how information is entered as well as retrieved.

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