- At last month's meeting of the Interoperability Experience Task Force, member of this collaboration between the Health IT Policy and Standards Committees identified five use cases to help improve the experience of health IT interoperability for both provider and patients.
According to the task force, essential to supporting these use cases is the ability of health IT to: identify patients and locate their records; locate and identify providers; access and interpret consents and authorizations; encode data that is syntactically and semantically interoperability; exchange health data.
Outside of technical capabilities, governance needs to play an important role in training users effective, ensuring accountability, and maintaining compliances with appropriate rules and regulations, the group noted.
So what gaps do the five uses identified by the Interoperability Experience Task Force reveal?
Transitions of care
The ability to send transitions of care information electronically has served a meaningful use requirement beginning in Stage 2 Meaningful Use of the EHR Incentive Programs. However, demonstrating this capability between two meaningful users falls short of real-world instances between any number or kind of providers, most especially those in emergency departments, needing high-quality health data to treat a patient effectively at the point of care.
To enable this form of information sharing, the task force highlighted the role of automated queries. For one, the EHR system in the ER must know where to look for external records which sporadic use of record location services or relationship listing services have as of yet not been able to provide. The task force noted this as a high priority moving forward. Concomitant with knowing where to search are who is the primary care provider and how can the EHR system contact him electronically.
Beyond finding a patient's health data, the EHR system must then be able to do something with it — that is, import external EHR data into the local system. Currently, many EHR systems are able to display these data but are unable to ingest them. The EHR system, likewise, must support the ability to notify the ER doc that external data have become available, a functionality that varies widely across practice sites, and with it a notification to notify the PCP that the patient was seen in the EHR, a feature only sporadically available to providers.
Share care plans
Interoperability Experience Task Force raised the use case of a team of providers sharing care of cancer patient and the needs it presents for access to a share care plan.
The group noted that a lack of a single standard places restrictions on the sharing of patient information for something as common as drawing blood. In an ideal scenario, the health IT system used by the oncologist draw blood should lead to a home health provider being notified to collect a specimen, the results of which are communicated to the oncologist and then the patient and other members of the care team, with the task ultimately marked as completed.
In the event that the home health nurse cannot collect a specimen, the order to draw blood needs to be escalated to the appropriate member of the care team and remediated.
The task force listed the need as high for all tasks related to a simple blood test.
The use case of a diabetic and caregiver highlights the important of giving patients the means to authorized access to blood data and submit Hemoglobin A1c data where appropriate based on readings from the patient's glucometer. The Interoperability Experience Task Force identified the potential for an application programming interface (API) via a health information exchange (HIE) or a direct connection to support a health data query.
Patient-generated data and lack of health IT standards and requirements for data, however, represent a high need, according to the group. The task force noted that patient-generated data is rarely integrated, between 10 percent and 20 percent of the time. Also necessary from a patient-generated-data standpoint are mechanisms for identifying the context of data (e.g., patient-entered) and who becomes responsible for the data send. The former historically has lacked governance; the latter, health IT standards for routing data appropriately.
Clinical information transparency for patients, providers
As complex as that phrase might sound, it comes down to the movement of health information as patients move throughout the care continuum. In the use case identified by Interoperability Experience Task Force, it is when a patient is discharged from the hospital.
While the task force admitted that the sharing of discharge summaries with patients, their PCP, caregivers, and other specialists, it is oftentimes fragmented and difficult to measure. What's more, many hospitals are only partially able to generate discharge summaries dynamically. What is severely lacking is the ability for members of the patient's healthcare teams to identify the patient and reconcile data with the patient chart directly, instead occurring manually.
For the patient and his primary care physician, medication lists, adherence, and reconciliation remains challenges. According to the task force, pertinent health data needs to be available to the PCP and patient and patient care team as well as include outpatient recovery orders and suggestions.
Without access to medication information management data or follow-up plans, patients are likely to become victims of ill-informed decision-making because of a lack of healthcare interoperability.
Improving care quality is at the heart of healthcare reform. However, members of quality management and healthcare organizations often lack the ability to interchange and review clinical quality data for individual patients or patient populations.
To improve this area, EHR technology needs to be able to identify where a patient resides, query the source for raw data, perform calculations on this data, and ultimately report calculated value to the appropriate federal agency or program. According to the task force, the need is being fulfilled so far as PQRS, meaningful use, accountable care organizations, and HEDIS are concerned. The sticking point is the ability to access data and perform calculations, both high priorities only partially fulfilled.