Q&A: Mass. hospital aims for seamless information exchange
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Fortunately, the facility can build on some of the lessons learned with its emergency department (ED), which is completely electronically record-enabled. LGH is also building a health information exchange (HIE) based on RelayHealth technology, and is about to begin exchanging ED data based on the Continuity of Care Documents (CCD) standard. CMIO recently spoke to Meehan about the driving force behind its electronic ED.
CMIO: What is LGH’s top priority?
Meehan: Interoperability is the biggest push right now. We use Picis [EMR software], and latest version of Picis came out this year, just as we were starting to get rolling with RelayHealth’s HIE. The new version of Picis has an HIE module that’s built right into the software, so there’s almost no interface necessary. It will receive very granular CCD documents, [and will] take allergies and medications, parse them into code, and put them into the actual components of the EMR, so it’s very seamless.
CMIO: How does this work?
Meehan: In the Picis structure, the patient comes in, gets registered in the ER, and as soon as that AO4 message hits our software, the software goes out and looks the XDS registry, and queries it back for information. The CCD is gathered, parsed at the Picis site, and populates the patient’s chart under external data. So when I go to the medications of this patient, when I’m doing the medication reconciliation gathering current meds, they’re sitting in the queue of that patient’s medications. The allergies are, too. The allergies are either from the old record from a previous ED visit, or from an HIE exchange. It doesn’t have to be RelayHealth; [Picis] can ping any one of these [XDS] registries.
Of course, all of this is done securely and only if the patient consents to release their information.
Picis has set it up so it can read very granular-looking data and on the way out, as patient leaves, it sends back a CCD to update that patient’s registry and will send out a complete report of the ER—what happened, visit, [etc ]. The primary care physician can then decide to release the information to the personal health record based on the content. Even if the patient is archived and physician wants to do his documentation a couple of days later, that will then go out and update the XDS repository, so it’s very seamless for the individual.
There’s no other portal, there’s no change in workflow, and it’s one of the slickest ways I’ve seen this work.
CMIO: Why is a seamless encounter important?
Meehan: The more workflow problems you have, the less [any healthcare IT system] going to be used. It often comes on separate software, with a different portal, and you have to connect to it via login. Most people who connect to an HIE and start looking at a CCD, a lot of times they just see the one rendering, text. Although text provides an important communication tool, codified data in the CCD is really at the crux of interoperability.
I don’t know of any other hospitals that do this out of their ER, parsing the information directly into their record without any change in workflow. Medications, allergies and problem lists are probably the most vital data that we have to obtain from this type of effort, and Picis covers a lot of that critical data for us.