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What A Green Three Ring Binder Says About the State of Meaningful Use and Health Information Exchange

The photo says it all.

The green notebook and pen represent the latest and greatest health IT innovations used by the hospital nurse to record my wife’s health information in the hours before her surgery to re-attach a fully torn Achilles tendon.

(Apologies for the cheeky intro and to my wife and anyone else for any HIPAA violations I may have committed in the capturing of this image).

It’s not that the hospital does not have an electronic health record.

They do – from a vendor widely considered a leader in the industry: Meditech. Same goes with the physician practice where she receives all her care and where her surgeon and primary care doctor are based.

They too have an EHR from another leading vendor: NextGen.

The problem? These systems are not connected. Thus, confirming the not so surprising news that health data interoperability has yet to make its debut in our corner of the NYC burbs.

Fortunately for my wife, she is well on her way to recovery (a bit more reluctant to juggle a soccer ball with her son in airport passenger lounges, but nevertheless feeling much better…and mobile). By everyone’s estimation – hers, mine, friends who suffered the same injury and friends who happen to be doctors – she received high quality care.

What’s more, we feel the overall patient experience at our physician practice and the hospital was quite good. That said, I cannot help but ask myself a series of ‘what ifs?’

What if…we forgot to mention a medication she was taking and there was a bad reaction with medication they administered as part of the surgery or afterwards?

What if… the anesthesiologist or surgeon couldn’t read the nurse’s handwriting?

What if the next time we go to the hospital, it is a visit to the emergency room and the attending clinicians have no ability to pull any of my family’s health records and we are not exactly thinking clearly enough to recall details related to medical history?


So here we are in 2014, the year when providers start earning incentives from the federal government for demonstrating their ability to electronically share health records with other providers using different EHRs (under the federal government’s incentives tied to Stage 2 Meaningful Use of electronic health records).

My personal experience in these matters has certainly been meaningful, but not in a good wayfirst with my dad and now with my wife.

And here’s the aspect of this that I can’t quite wrap my head around. It’s not like we are talking about competing health systems. My friend Zina Moukheiber has raised this issue in some of her outstanding reporting on the topic of interoperability and health information exchange – i.e., how HIE is held back by competition between health systems as much as if not more than barriers related to technology.

Our physician practice is one of the largest in our area with over 300 physicians. So while they certainly offer some of the same ancillary services as the hospital (e.g., CAT scans, ultrasounds), the practice is affiliated with the hospital and drives a substantial amount of referral business.  Did I mention that the hospital is literally across the street from the other doctor’s office?

So why then are these two provider organizations and their EHR systems not connected? Is it just a question of technology? How big are the cultural barriers?

The good news is that recent developments have paved the way for both EHR systems to connect. Our physician practice recently upgraded its NextGen EHR to a version that gives them the ability to exchange CCRs and CCDs.  And Meditech recently added its name to the list of vendors who are working with a leading nationwide network to facilitate interoperability and health information exchange.

So, sometime in the very near future, these systems will have the ability to connect and share health information. If my neighbors only knew the breakthrough that is upon us!

So now it would seem to be a question of commitment and timing by the leaders of both organizations. If I or members of my family are unfortunate enough to make another trip to the hospital in the next year, I will be sure to report back in the future on what I hope is a story of progress (and speedy recovery towards good health).

So what has been your experience with your local providers? Are clinicians at your hospitals and doctors’ offices still using three ring binders, pens and paper to capture your health information…with you acting as the primary source of clinical information? Or has all your pertinent clinical data already been electronically communicated and integrated into the providers EHR in advance of your visit?

We look forward to the discussion around this and related topics at next week’s HIMSS conference. See you in Orlando!

Rob Cronin leads the Digital Health practice at W2O Group, a marketing and communications consulting firm.

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Elliot BarryS Silverstein MDPerrylegacyflyer Recent comment authors
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Elliot Barry
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Recent developments have paved the way for both EHR systems to connect. Our physician practice recently upgraded its NextGen EHR to a version that gives them the ability to exchange CCRs and CCDs. By everyone’s estimation – hers, mine, friends who suffered the same injury and friends who happen to be doctors – she received high quality care.

S Silverstein MD
Guest

It turns out many, many docs are unhappy, and the dangers are starting to now come out from the shadows.

Two new major recent stories.

Patient Safety & Quality Healthcare: “Malpractice Claims Analysis Confirms Risks in EHRs”
http://hcrenewal.blogspot.com/2014/02/patient-safety-quality-healthcare.html

“EHRs: The Real Story” – Sobering assessment from Medical Economics
http://hcrenewal.blogspot.com/2014/02/ehrs-real-story-sobering-assessment.html

With links to source.

Perry
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Perry

“The only explanation for that is either incredible stupidity or large campaign contributions – I believe the latter.”

I think both, legacy.

Perry
Guest
Perry

I find it ironic that the government can’t even get a website for healthcare right, yet they’re squeezing the medical community into questionably useful EMRs. This whole thing is going to get even better in October when ICD-10 comes out.

legacyflyer
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legacyflyer

The fundamental problem is that the cart got put before the horse. It does not take a rocket scientist to figure out that for EMRs to be of use in transferring data between organizations, they must talk to each other. However, adoption of EMRs and meaningful use were pushed (by the government) in an environment where the EMRs don’t talk to each other !?!? The only explanation for that is either incredible stupidity or large campaign contributions – I believe the latter. And the user interface with most EMRs is bad – most physicians find that using an EMR slows… Read more »