Better clinical decision-making for higher quality care delivery will be the key component.
By Gifford Boyce-Smith
As healthcare providers scramble to review budgets to capitalize on the incentive opportunities for EMR deployments of the American Recovery and Reinvestment Act (ARRA), there remains the question: What will qualify as "meaningful use" in the eyes of the secretary of Health and Human Services (HHS)?
This uncertainty has caused many providers to hesitate before investing in an EMR solution. For those with established EMR systems, there is a growing concern that their legacy systems will not meet the as-yet-to-be-defined criteria for meaningful use, which could then result in costly tear-outs and lost ROI.
Meaningful use is a simple concept: Patient data should be quickly and easily accessible by a patient's care team, enabling better clinical decision-making for higher quality care delivery. The elements of this vision are equally as simple. First, the adopted technology should enable a continuum of care. When a patient visits the emergency room, the emergency department (ED) clinician should be able to access the patient's complete medical records to review past diagnoses, lab tests, prescribed medications and other data. - essentially, wherever care has been delivered previously throughout the community. With this longitudinal view of the patient's community medical record, the clinician can more accurately assess and treat the patient's condition; avoid unnecessary and duplicate tests and procedures; and be informed about potential safety issues, such as previous and existing medications and allergies.
When a patient arrives at the ED complaining of stomach pains, for example, the ED physician should be able to review the patient's medication history. In so doing, that clinician might learn that the patient is currently on an arthritis medication, but has failed to refill her H-2 Antagonist. With this new information provided by better healthcare data connectivity, the clinician might reasonably assume the patient has NSAID-induced gastritis. Without this knowledge, many unnecessary tests, including upper GI X-rays, might be performed as part of the initial assessment of the patient's current condition. This use of technology would probably be defined as "meaningful." As evidence indicates, better data access leads to a better and less-costly outcome for the patient.
In another example, an ED patient may be flagged for anemia, triggering a range of tests indicated by this diagnosis. Conversely, with complete access to the patient's medical history, the clinician might discover that past laboratory results showed chronic anemia with iron studies consistent with "anemia of chronic disease." Again, additional duplicate tests could be avoided and reassurance would be all that would be necessary.
Critical to transforming data into meaningful data is correctly locating, identifying and matching patients throughout disparate care locations. In addition to the patient's inpatient record, there may be seven to eight outpatient records housed within distinct healthcare service provider systems, possibly across competing care providers. Each of these applications (e.g., local pharmacy chain stores, reference laboratories, imaging centers) may use different nomenclature for the patient and may house different demographic elements (e.g., address, SSN, DOB). In other words, John Smith may appear as Mr. J Smith in one application, John M. Smith in another and John Smith in yet another.
To ensure that providers are viewing the right information correctly linked to the right patient, the interoperability solution should employ a record locator service and community master patient index. These technologies locate, match and merge all the data streams of patient information from laboratories, pharmacies, EDs and specialists, allowing for correct patient identification at the enterprise level (within the laboratory) and correctly matching patient information across each enterprise at the community level. In the end, clinicians can be confident that clinical results and history are attributed to the right patients.
To enable this level of fully connected care, the underlying technical platform should support secure data exchange with the broad variety of healthcare IT solutions already installed in the provider environments. Will the lab data, pharmacy data, radiology images, and EMR records all communicate with each other? With the right interoperability solution, the answer is "yes."
Additionally, providers just beginning EMR deployments will insist on assurance that today's purchase will meet the future compliance criteria as it relates to the ARRA. Given this reality, interoperable, vendor-agnostic solutions that can be customized to address a spectrum of scenarios will be a prerequisite for achieving meaningful use.
Interoperability can also be interpreted as working within the physician's current work flow, including traditional communication methods such as fax or printers. Thus, interoperable solutions should offer a means to integrate with the clinician's current environment and enable improvements in work flow, without causing additional administrative burdens. The clinicians should use the technology to achieve the goal of meaningful use; that is, improved patient care.
Interoperability with disparate systems outside the four walls of the health system, is the realm of health information exchanges, a platform of connectivity spotlighted by CHIME's recent statement on meaningful use. As former competitors come together to share data to create a common view of patient information, healthcare data silos will disappear and the meaningful application and use of EMRs will emerge. The goal of regional, state and national networks will then be realized, ensuring evidence-based, high-quality care throughout the patient's life.
Gifford Boyce-Smith is the chief medical officer at Medicity, Salt Lake City, Utah.