There are signs that partisanship in Washington may be waning.
Interoperability, the need to share medical information from disparate electronic health record systems, is uniting at least two Senators from either side of the party divide. Republican Lamar Alexander of Tennessee calls efforts to exchange health information “a glaring failure.” He goes on to say, “It’s a great idea; it holds great promise. But it’s not working the way it’s supposed to. The current standards for Meaningful Use aren’t clear. Upgrades are expensive. The systems don’t work to share the data; we hear it’s expensive to share the data because of some of the relationships between vendors and doctors.”
Democrat Elizabeth Warren of Massachusetts expresses anxiety about mismatching patient information even if EHRs become more interoperable. She cites a RAND Corporation study that estimates hospitals mismatch patient information about 8% of the time even with data management software and personnel dedicated to solving the problem.
Frankly, neither critique is particularly helpful. Everybody knows we are in the midst of a health data explosion. Information that could theoretically be stored in 10 billion four-drawer cabinets only three years ago will require 500 billion four-drawer cabinets in just five years. Would either Senator or anybody else suggest that all of this data doesn’t need to be shared?
Archive for the tag 'HIE'
Interoperability is critical to achieving value-based care. It not only facilitates care management and coordination efforts, but also drives the collection and analysis of clinical data to derive new insights. However, the overwhelmingly vast array of available enterprise health information technologies, competitive economic concerns, and the long-standing legacy of siloed healthcare have stymied efforts to build interoperability and hindered new approaches to care delivery and payment.
Please join eHealth Initiative and Galen Healthcare Solutions for a webinar panel discussion on October 1 to learn more about the complex impediments to interoperability and how different stakeholders are overcoming these challenges. Panelists include:
- Ray Lape, Director, Technical Services, Galen Healthcare Solutions (Moderator)
- Margaret Donahue, MD, Director, Veterans Health Information Exchange; Co-Director, Office of Interoperability, Veterans Health Administration
- Robert White, MD, Medical Informatics Director, ABQ Health Partners
- Scott Carrell, Executive Director, Idaho Health Data Exchange
- Jay P. Lee, Manager, Healthcare Interoperability & Innovation, Huntington Hospital
As a consultant in the healthcare information technology field, we have different perspectives on anything relating to medical care. We see things through a different set of eyes if you will.
Me: Hi mom, how are you?
My Elderly Mother: Good
Me: How’s dad?
Mother: Eh, you know your father, grumpy, tired, and bossy. He can’t understand why his knees are not any better after his surgery and he still can’t go for a walk in the woods. He’s 84 but still thinks he’s 50!
Me: How are his Coumadin levels? Didn’t you say he was told to start taking amiodarone? Has he been to the kidney doctor recently?
Mother: His Coumadin level is good and they switched him to some drug with an X? (Xarelto). He is still having those dizzy spells and they can’t determine why. As for the kidneys, we were told his GFR levels are a little better.
Me: Did you talk to the doctors about all the different meds he is on? You two need to make sure each doctor he sees is aware of what medications he is taking.
Mother: Well every time we go to one doctor, it seems like they add or change a medication and don’t ever discuss it with the other doctors. Like these tan pills here. We saw one doctor on Thursday, picked up these new pills on the way home, and then the next Wednesday, saw his kidney doctor who said “stop taking those, you should use this instead.” So now we have a whole bottle of pills that he needs to stop taking, and a new bottle coming in the mail that he needs to start taking. It is getting to the point where he is so tired of all the appointments and all the changes that he is ready to stop taking the meds and stop going to the doctors all together.
Me: Oh my goodness Mom, no wonder he is dizzy. He may be having some sort of interaction. Okay, we need to plan a meeting with one of his doctors and find out who should be managing all of his meds to determine if some are reacting with others. It’s not working for him having to go to two different health systems, and those doctors are not great about sharing the information with each other.
As people start having health issues, it is important for them to understand their illnesses and what each medication they are given is intended to do. For many patients, managing the treatment is more of a challenge than the disease or health issue itself. This is true for patients of any age, though it has become very apparent for the older generation. Some patients facing chronic or acute diseases have the luxury of having family close by that can help monitor their situation. Others are not as lucky to have someone available to assist them in managing their care, and this can become a challenge for anyone facing treatment of a health issue or disease.
Having multiple doctors prescribing medications and recommending tests can lead to prescription confusion, redundant testing, missed appointments, and ineffective treatment plans. More often than not, patients assume providers are communicating medication changes and test orders to one another. Unfortunately, the aforementioned scenario with my father is all too common – patients are prescribed so many different medications that it can not only get confusing, but also lead to potentially dangerous or life-threatening situations.
Situations like these really illustrate the need for connected and coordinated care. Heath information exchanges (HIE) are making progress to connect the data silos that house valuable patient information. Other solutions involve patient care teams that manage all the moving pieces of a patient’s care plan. These efforts are being buttressed by applications such as PinpointCare, a platform that empowers all members of a patient care team to manage and collaborate on a patient’s care plan in real-time, regardless of care setting or native EHR. Efforts like these reduce communication breakdowns between incompatible EHRs and facilitate a patient-centric care system. For more information on PinpointCare, patient engagement, or care coordination, feel free to contact us!
Recently, Galen’s technical consultants took part in a large state Health Information Exchange’s (HIE) migration from Axolotl HIE to the Orion HIE platform.
Often times, connecting a participant to an HIE means compromising between two sets of standards to find a maintainable medium. Having a flexible, driven team of passionate consultants committed to the long-term success of a project can be the difference between a successful and an unsuccessful endeavor. These are some of the challenges faced throughout the HIE migration that were overcome with our technical experience and dynamic solutions.
Normalizing Converted Data With Minimal Background Information
When migrating from one HIE vendor to another, it is imperative to backload historical data to perpetuate the data repository built up over years on the legacy system.
Decisions are often made in healthcare IT to overcome limitations of a system. These choices can cause unforeseen downstream issues, especially when migrating to an HIE with a different set of specifications and standards. In many situations, decisions made in the past aren’t well tracked and the reasoning for handling the data isn’t easily discernable. Over long periods of time, these issues become magnified, especially when they involve multiple data sources. As issues are discovered, adjustments are made to mappings and resolutions are developed on the fly, though the documentation around these decisions is sometimes inadequate and difficult to follow.
Galen’s team of interface analysts is uniquely equipped to identify patterns in data sets and develop solutions to overcome the transition to a new HIE. With our extensive interface knowledge and experienced team of healthcare IT professionals, Galen can provide a deep understanding into how data is changing over time, discern the specific reasoning behind why decisions were made, and determine how best to move forward with the information and tools that are available.
Managing Reused Patient Identifiers
HIE systems require that patient identifiers (e.g. MRNs) be unique. That is to say, each patient identifier that comes into an HIE from a particular facility should be distinct to a patient, and should never be reused on another patient.
There are instances where this isn’t the case in HIT, for example, reference labs will sometimes recycle patient identifiers used in previous years. In order to retain the uniqueness, identifiers need to be intelligently manipulated. Galen’s interface analysts have experience dealing with this situation and can help partners develop customized solutions to overcome this challenge.
Managing Reused Message Control Identifiers
Some interface engines also require that each HL7 message have a unique message identifier in the MSH-10 field. If an HL7 comes in with the same message ID as one that was previously processed by the system, the interface engine knows to reject that message (typically, this would be a repeat message). Some participants do not or cannot send a unique MSH-10. In these cases, Galen’s analysts have collaborated with partners to develop creative solutions to circumvent these limitations when converting data from legacy systems.
Managing Order Codes with Multiple Descriptions
Order codes should be unique to the order description they align with, although there are instances in the real world where this isn’t the case. Sometimes, facilities send the same order code (OBR-4.1) with distinct order descriptions for results that are actually different. Take a microbiology result for example: a facility might provide an order code of MICRO with an order description (OBR-4.2) of URINE CULTURE, but they might also send an order code of MICRO with an order description of BLOOD CULTURE.
In some HIE systems, the first description loaded with the order code of MICRO is the description that will always display in the patient portal whenever a subsequent result with the same code of MICRO is processed, regardless of the actual description code. Let’s say a patient first has a URINE CULTURE resulted, then a few months later, that same patient has a BLOOD CULTURE resulted. That BLOOD CULTURE result is going to display in the patient portal as a URINE CULTURE because the system has already been populated with:
|Order Code||Order Description|
Galen has developed a methodology for working through this issue. Our analysts can help organizations create a customized strategy for appropriately handling order code and order description data to enable an HIE to correctly display order codes with multiple descriptions.
Properly Linking Microbiology Results to Susceptibilities
Microbiology results are especially tricky when dealing with any consuming system. Depending on whether the result indicates a need for further testing, microbiology HL7 results contain either:
- Just the initial microbiology result
- Both the initial result and susceptibility follow up results
When a microbiology result does require a susceptibility follow up, it will typically have two OBR segments. The first OBR segment will pertain to the original culture like a Blood Culture or a Urine Culture. The second OBR segment will contain information regarding results for the associated susceptibility.
Many systems require that the child (susceptibility) report contain elements from the parent result, though participants don’t always send this information in the parent report appropriately. Galen is adept at identifying the patterns with which a participant sends their microbiology results, and our consultants have extensive experience developing logic to appropriately process microbiology results into consuming systems.
Overall, there are many challenges that can arise when converting from one HIE to another. Galen Healthcare Solutions’ experienced interface analysts and HIE specialists can work with you to ensure a successful and timely migration that best serves your patients and physicians. For additional information, feel free to contact us!
Co-written by Matt Hoover and Matt Leyva
On Wednesday evening, ESPN reporter Adam Schefter tweeted an image of an NFL athlete’s personal medical records that set the twittersphere ablaze and had #HIPAA trending throughout the nation. This setup an interesting Thursday morning for us here at Galen, where three of our biggest passions, Healthcare IT, patient advocacy, and professional sports, collided (well, four if you count fireworks safety – seriously, ask your favorite Galeneer about that). The reactions ranged from disbelief to disdain, but predominantly disappointment. These types of events erode the inherent trust in a patient-provider relationship that we collectively work to cultivate as an industry. As trust is lost, patients may start intentionally withholding pertinent information from their providers which could be critical to ensuring that proper care is delivered at the appropriate time.
Initially, Schefter was inundated with backlash for this blatant HIPAA violation. Was his decision to tweet the image morally justifiable? We all have our opinions, but let’s not get into that right now. Was Schefter in the wrong? From a HIPAA standpoint, both he and ESPN are non-covered entities that fall beyond the bounds of HIPAA regulations, and his actions are legally defensible by the First Amendment freedom of speech clause. The primary offender, assuming this patient did not provide consent to share his medical records, are the parties belonging to the covered entity who initially leaked the information. As with similar cases, this flagrant disregard for HIPAA laws will almost certainly warrant punishment – up to $50,000 in civil penalties and up to $250,000 with a maximum of 10 years imprisonment for criminal penalties.
Situations like this will make patients think twice before sharing information due to fear it may not remain private. It is counterproductive to the efforts so many in the HIT community are pushing to accomplish, especially as we strive towards increasingly connected systems and improved interoperability with applications such as Health Information Exchanges (HIE). Whether the victim is a Grammy-winning superstar, an Oscar-lauded actor, an all-star athlete, or an average Joe, this isn’t the first instance of unauthorized individuals accessing and/or disclosing ePHI. It’s probably not the last either, but if there is a silver lining takeaway, maybe it’s that this incident raises awareness and precipitates a change in behavior relating to HIPAA, both in the HIT arena and the media.
For any additional questions about HIPAA or the guidelines that Galen and the HIT industry follow, feel free to contact us at email@example.com.