With a plethora of healthcare information systems available to them, providers across the spectrum of care are able to capture more patient data than ever before. That's the good news. The bad news is that this information, typically stored in data silos, is not necessarily accessible when and where the provider needs it.
Consequently, providers in group practice settings are often unable to review information that can significantly impact care plans for their patients. Even if a practice belongs to a health system or consortium that networks various health information technologies, providers must take the time to log in and out of multiple password-protected databases - which may or may not be current, and may or may not produce information in a useable format.
Medical groups, in conjunction with other community providers, increasingly are exploring interoperability platforms that create a unified record from the various sources generating patient data, even if they originate and are stored within disparate technology systems. This functionality allows an easily accessible, up-to-date longitudinal patient record to be delivered within seconds to any provider at the time of care.
positive impact on quality, safety
The quality and safety benefits are endless. The University of Pittsburgh Medical Center (UPMC) began implementation of an interoperability platform early in 2008, with owned and affiliated medical groups reporting an overwhelmingly positive impact on their ability to deliver a higher level of care. With as few as three mouse clicks, providers can view such information as current essential data sets (problems list, medications, allergies, procedures and immunizations) and most recent lab values - even if the patient saw various specialists. The solution integrates and delivers discrete clinical information elements at the point of care. This functionality exceeds other available solutions, which simply store documents for review and require providers to assume the burden of reconciling information delivered from many sources.
The advantages of this level of access to information are bi-directional between ambulatory and inpatient settings:
n Community providers conducting rounds in the hospital or other facility will have outpatient records at their fingertips - fully integrated with the inpatient record - so they have a comprehensive view of their patient's current condition, care plan and prognosis. Likewise, they will have immediate access to discharge summaries, follow-up orders, and new medications or therapies that were prescribed.
n At the same time, practices will gain confidence that other specialists, hospital attendings or residents will have a complete picture of the care they have been providing in the ambulatory setting, increasing efficacy and reducing the chance of medical error.
One of the biggest clinical "wins" UPMC has identified as a result of interoperability relates to medication allergies and patient safety. Recently, for instance, a new patient told his provider during an exam that he was unaware of any previous drug allergies. Interoperability enabled the provider to quickly verify that information - which revealed that another physician had indeed documented an allergy to the drug about to be prescribed.
There are challenges that accompany interoperability, of course. The volume of data suddenly at providers' fingertips may result in "information fatigue," for instance. In addition, health care organizations creating interoperable systems may want to regulate the flow of certain data elements. Should all details of a patient's personal, family and social history be made available throughout the enterprise, for example? To overcome these obstacles, interoperability solutions need to understand the meaning of the data - and use that meaning to organize and filter information for the clinician. To date, only a few solutions offer this kind of capability.
The cost of building interoperability platforms - often in the six-to-seven digit range - require that groups of providers collaborate for maximum gain. Clearly, interoperability offers minimal value within a single practice. But when health systems and independent delivery networks drive the initiative, patients, providers and healthcare organizations all can benefit.
Medical groups attuned to industry trends recognize the value - and inevitability - of increased health information exchange. Fortunately, platforms supporting interoperability between disparate technology systems hold much promise to assist providers in improving the quality and safety of the care they deliver to their patients.
Anthony Fiorillo, MD, serves as the medical director, ambulatory eRecord and Kevin O'Toole MD, as assistant chief of emergency services for UPMC.
