This is a
blog intended to help share information about Health Information Exchange obstacles
we’ve encountered and how we overcame them, or in some cases how we wish we would
have handled them differently.
While the
intent is for this to be somewhat technical, we are not dogmatic about our
specific solutions. There is typically
more than one arguably correct way to solve a given problem. Ultimately, it’s all about the people. Understanding what the patients, nurses,
administrators, medical receptionists, and physicians want from their Health IT
comes first.
We believe that
secure, properly implemented health information exchange does help those people
by improving care outcomes and reducing costs.
We have personally seen patients’ treatments altered in a positive way
as a result of our data sharing initiatives.
For example, at Great Lakes Navy, when we installed an imaging pilot for
sharing radiological image data with the Veterans Affairs (VA), a patient being
treated for a chronic lung condition was discovered to have an image of his
chest from the VA several months ago wherein his lungs were clean. The realization that this was an acute
condition rather than a chronic one changed the patient’s treatment and likely resulted
in a better outcome. Other benefits frequently
noticed include:
- Improved outcomes
- Healthcare providers seeing the allergies and medications that other healthcare organizations have on file for the patient reduces their chances of prescribing the patient something that they’re allergic to or that interacts negatively with another drug that the patient might take at the same time.
- Decision support software can check for such problems automatically when a drug is prescribed electronically and the information is available
- Often, the rate of growth of a nodule is more important than its current size. Data sharing can allow a physician to see what the size in a radiology report earlier in time from another facility.
- An ER team attempting to diagnose and treat an unconscious patient can benefit from a medical history being available from data sharing initiatives.
- Reduced costs
- Prevents duplicative work. (e.g. Lab results being shared can prevent unnecessary redundant lab work)
- Improved care coordination reduces the chance the patient needs to return due to complications.
Many of us have been doing health information exchange work, and HIE work for the VA and DoD in particular, since the late 90s. My history with Ellumen’s board of directors begins with the Government Computer Based Patient Record (GCPR), which was the first project of many setting out to make a standards based interface for electronic health data sharing between VA and DoD. Back then, the standard we were told to use were the Object Management Group’s (OMG) CORBAMED specifications. These were CORBA IDL based standard interfaces. The GCPR prototype project was followed by the successful production implementation of the award winning Federal Health Information Exchange (FHIE) and Bidirectional Health Information Exchange (BHIE) programs. FHIE/BHIE was one of five winners of the prestigious Excellence.Gov award from the American Council for Technology for demonstrating best practices in information sharing for federally led IT program implementations, and I remember that work fondly.
Over the
years, standards evolved, the DoD deployed AHLTA worldwide, and new VA/DoD
health data sharing initiatives such as CHDR were begun to implement new
standards for new systems in a new way.
The standards evolved even more, and VLER was implemented to allow VA
and DoD to share data using the new IHE Profile based standards being
recommended by Health and Human Services (HHS).
This was followed by a period of time, where the DoD and VA were
planning to build just one EHR system that both agencies would use and that
would share data through an enterprise service bus (ESB).
We have been
involved in all of these systems in one way or another in addition to our
commercial health data sharing work. In
some cases we were doing architecture, design, and initial development which
involved reviewing standards and implementing standards. In other cases we were taking over
development and sustainment of an existing system as well as production
operations, monitoring, troubleshooting, and reporting. In many cases we have been in charge of the
Information Assurance (IA) and security of the system.
It is our hope
that this broad range of experience will produce insights useful to the Health
IT community. I intend for future posts
to be more technical than this introductory post, but I feel it’s appropriate
to qualify us a little bit in this first one.
Still, I think we can pull some broad overarching lessons out of this
history. Putting the people the system
is supposed to benefit first is an obvious take away, but I think most of us
already know that. Possibly more
insightful is the notion from our experience that there are many different
types of health IT standards and that each type of standard frequently contains
multiple competing standards. Today’s
chosen standards may not be tomorrow’s.
To overcome that obstacle requires clever layering in the design of
software to ensure that new adapters can be built to accommodate future
network, message, and security protocols.
As for terminology standards support, that’s a topic plenty big enough
to be the next post…
So tune in
and please provide feedback in the comments section if you have additional
insights.
