The 21st Century Cures Act and Trusted Exchange Framework and Common Agreement (TEFCA), combined with the widespread adoption of the Fast Health Interoperability Resource (FHIR) standard will soon drive interoperability of health information all the way from the enterprise to the patient. These two regulations, and the FHIR standard, will serve to set up the “pipes” to connect the points where healthcare information is acquired, and where it is eventually accessed and used.
FHIR defines a basic structure for what goes into the pipes, but still enables the sending and receiving of just about anything encountered in a medical setting. This can include codes, represented by various terminologies and code sets, free-text narratives, images, operative notes, discharge reports, patient summaries and problem lists, lab results, orders, and other things. It is an intentional catch-all to include a wide variety of content. You can put just about anything into it. The question is, what do you with it when it comes out of the other end of the pipe?
This has been referred to as a potential “data tsunami,” which is a bit of a misnomer since only some of it will be actual data. On the receiving end, the main challenge will be what to do with the data, how to filter it, organize it, and put it to work at the point of care.
Going back to the basics, “inter” is defined as “between” and “operable” is defined as “functional, practicable, or usable.” So, 21st Century Cures, TEFCA, and FHIR take care of how to move information between systems. The remaining (and daunting) challenge is the ability to do something with it all when the faucet is opened at the receiving end.
Recent articles in the industry press point out the issues that the VA and DOD have had exchanging information between their systems and with clinicians being able to find what they need when they need it. Users report issues that may negatively affect patient care. These issues are between systems using the same core product, so imagine the additional complexity of sharing information between disparate systems.
In a completely open environment between disparate systems not using the same core product, the challenges to “operability” on the receiving end are going to increase. Users will need powerful tools to filter incoming information and organize it so that clinicians can make use of what they need without wasting time sorting through everything else. Population analytics can help to evaluate trends in a group of patients, but how do you make it useful at the point of care on an individual patient level?
In any transmission system where you can put just about anything you want into the pipes, a filtering system is required on the receiving end. Ignoring free-text narratives for a moment, let’s talk about clinical data coded in the various terminologies and code sets commonly in use. The combined number of possible codes in ICD10-CM, SNOMED, LOINC, RxNorm, CPT, HCPCS, DSM5, UNII, CVX, and CTCAE total more than 200,000––any of which may be relevant for a specific patient. A key requirement in the coming world of 21st Century Cures, TEFCA, and interoperability will be to enable a clinician to see a diagnostically filtered view of that incoming information for a specific patient and for any specific patient problem or condition.
The ideal solution is to enable a clinical user to select any item on a patient’s problem list and instantly see the relevant information for that problem including the symptoms, history, physical exam findings, lab orders and results, procedures, therapies, co-morbidities, and potential complications and sequelae.
This is the approach taken by CPSI in their new Patient Data Console, in which a single click on a patient problem displays specific data related to that condition. It ties together diagnoses, medications, labs, and other information for any problem and lets the clinician switch between problem-oriented views for each condition and to take appropriate action.
Regardless of the source of the information and how it comes through the pipes, users of CPSI’s Patient Data Console will have operational use of the information at the point of care. The pipes handle the “inter” and the Patient Data Console addresses the “operability” parts of interoperability.
“Previously when using EHRs, I had to work for the computer and I didn’t like it,” says Bill Hayes, MD, MBA, chief medical officer of CPSI. “With Quippe Clinical Lens, the computer goes through the huge volume of data in a patient’s chart and brings me the relative, high-value clinically connected concepts for the problem I am treating the patient for that day. Medicomp has done the work to change how systems can function and empower the clinician at the point of care.”
Patient Data Console is clinically responsive to the information needs of the clinician for a specific problem. The next challenge is to make the workflows clinically responsive to both the needs of the clinician and the requirements of the enterprise for documentation, compliance, quality data capture, analytics, and reporting––all of which are increasingly vital as the industry moves to value-based care.