HIMSS: Information exchange meets the real world
ORLANDO, Fla.— Healthcare quality depends on accurate records, asserted Richard Taylor, MD, CMIO of Providence Health and Services in Portland, Ore., during the Feb. 23 educational session “Health Information Exchange at the Bedside: Promise meets Reality” at HIMSS11.
We have to exchange health information, said Taylor, who referred to accountable care organizations and bundled payments as key factors pushing the new level of information interchange. What’s more, current methods for exchanging data—phone, fax and snail mail—have reached their limits, he said.
Taylor explored the process of marrying real-world workflows to new models of information exchange as he shared a pilot project completed at Providence Health and Services, a 27-hospital, open-model integrated delivery network that uses 27 EMRs.
The pilot project, which took place in 2010, focused on medication and allergy information exchange among EMRs, using a small critical access hospital in Seaside, Ore. as its test case. Key functions of the exchange project included advanced computer control over the interaction, automated publication at the encounter and clinician confirmation or rejection of data before inclusion into the record to avoid spreading bad data.
During the pilot, the hospital recorded 300 admission/discharge pairs with 25 percent of admissions referred to other facilities, 3,000 clinic visits and 100,000 CCD publications. The pilot team reviewed multiple outcome measures including consumption events, noise level (false or unimportant changes) and recurring problems highlighted for intervention.
Noise varied from 5 percent to 90 percent of changes, and was highly patient-dependent, with charts of frequent fliers more prone to noise than simpler handovers. The Portland organization also reported initial coding fidelity of 75 percent of top 100 medication lists and final fidelity of nearly 100 percent.
However, Taylor observed that medication coding is a significant issue requiring specific entry of coded medication. Common medications, such as aspirin and warfarin, presented the most problems. In addition, some prescriptions such as orders for wheelchairs lack a common code. The health system's response, explained Taylor, was to intensify vendor engagement, provide additional user training and scrub the data.
When the pilot team observed highly variable workflow among providers it responded with additional training. In fact, Taylor claimed that the largest barrier to health information exchange is the individualized nature of medicine. Both clinical list workflows and discharge handover, he said, are extremely variable.
Workflow posed additional challenges as workflow discrepancies and technical issues interfered with provider acceptance of information exchange. The team addressed the challenge by re-focusing on workflow, developing models for re-engagement and revising features.
The final barriers included obsolete data (which shouldn’t be exchanged), data entry standards and technical issues. Taylor urged other organizations to assess progress toward meaningful information exchange by reviewing data consumption by providers, measuring coding fidelity and the utility of information. Finally, he suggested healthcare remain vigilant about looking for opportunities to simplify workflow and reduce errors.
We have to exchange health information, said Taylor, who referred to accountable care organizations and bundled payments as key factors pushing the new level of information interchange. What’s more, current methods for exchanging data—phone, fax and snail mail—have reached their limits, he said.
Taylor explored the process of marrying real-world workflows to new models of information exchange as he shared a pilot project completed at Providence Health and Services, a 27-hospital, open-model integrated delivery network that uses 27 EMRs.
The pilot project, which took place in 2010, focused on medication and allergy information exchange among EMRs, using a small critical access hospital in Seaside, Ore. as its test case. Key functions of the exchange project included advanced computer control over the interaction, automated publication at the encounter and clinician confirmation or rejection of data before inclusion into the record to avoid spreading bad data.
During the pilot, the hospital recorded 300 admission/discharge pairs with 25 percent of admissions referred to other facilities, 3,000 clinic visits and 100,000 CCD publications. The pilot team reviewed multiple outcome measures including consumption events, noise level (false or unimportant changes) and recurring problems highlighted for intervention.
Noise varied from 5 percent to 90 percent of changes, and was highly patient-dependent, with charts of frequent fliers more prone to noise than simpler handovers. The Portland organization also reported initial coding fidelity of 75 percent of top 100 medication lists and final fidelity of nearly 100 percent.
However, Taylor observed that medication coding is a significant issue requiring specific entry of coded medication. Common medications, such as aspirin and warfarin, presented the most problems. In addition, some prescriptions such as orders for wheelchairs lack a common code. The health system's response, explained Taylor, was to intensify vendor engagement, provide additional user training and scrub the data.
When the pilot team observed highly variable workflow among providers it responded with additional training. In fact, Taylor claimed that the largest barrier to health information exchange is the individualized nature of medicine. Both clinical list workflows and discharge handover, he said, are extremely variable.
Workflow posed additional challenges as workflow discrepancies and technical issues interfered with provider acceptance of information exchange. The team addressed the challenge by re-focusing on workflow, developing models for re-engagement and revising features.
The final barriers included obsolete data (which shouldn’t be exchanged), data entry standards and technical issues. Taylor urged other organizations to assess progress toward meaningful information exchange by reviewing data consumption by providers, measuring coding fidelity and the utility of information. Finally, he suggested healthcare remain vigilant about looking for opportunities to simplify workflow and reduce errors.