According to the Office of the National Coordinator (“ONC”) the purpose of interoperability in Health IT is the following:
Interoperability ensures that health-related information flows seamlessly from General Practitioner, to Specialist, to Hospital, to Post Acute Care and to Patient. In other words, the patient’s information follows the patient regardless of geographic, organizational, or vendor boundaries. Specifically, Interoperability refers to the architecture or standards that make it possible for diverse electronic health record (EHR) systems to work compatibly in a true information network.
With these purposes in mind, the following types of sharing are most important in LTPAC:
During Transitions of Care (TOC), the successful movement of a patient from one healthcare setting to another in an efficient manner with all the important information migrating from one setting to another. The most important clinical information is the reason for transition, current diagnosis, recent medical events and treatments, allergies, lab results, recent vitals and current medications. For the caregivers at the receiving setting to know as much as possible and as quickly as possible is part of the properly designed TOC.
Bi-directional interfaces with the contract pharmacies for speed and accuracy in medication ordering. Additionally, the sharing of TOC information with the pharmacy improves the transition and medication reconciliation process to prevent errors of omission and contraindication.
Routine sharing of medical information includes lab orders and results, radiology reports and reports from medical specialists. Several benefits are derived from this sharing; it provides a history of information and helps to avoid the duplication of costs.
The next critical factor is the speed of information flow. For maximum benefit the sharing of information should be real-time. The use of paper or e-faxes slows the process and doesn’t make the information available immediately to the receiving entity. Electronic messaging that flows seamlessly from one system to the other is the desired method. Some vendors employ e-faxes as a form of communication which has many weaknesses including: it is slower, subject to human mistakes upon receipt, requires manual entry into the receiving system and is not immediately usable by the receiving EHR system and the front line caregivers.
Using standard electronic messages and communication protocols is the next important factor. Disparate systems must be able to send, receive and use the information immediately. The receiving system must be able to interpret and convert the information into a useful form for presentation and consumption by the receiving caregivers. The appropriate standards for messages, content and communication protocol have been developed and adopted by many organizations in recent years. These standards are incorporated in the EHR certification process as set forth by ONC and included in the definition of “Meaningful Use.” A certification from CCHIT (The Certification Commission for Health Information Technology) assures that the EHR system is capable of interoperability, as defined. A lesser certification type is the ONC functional certification. A system that is ONC certified means that specific functions have been certified but not necessarily the full function of interoperability.
LTPAC is changing rapidly and the demand for information sharing is increasing at the same rate. With the introduction of ACOs, managed Medicaid, the desire to prevent avoidable readmissions and the frequent TOCs among multiple sites and levels of care, the proper sharing of accurate and timely information is mandatory. The method of sharing of information in some instances may be through HIEs (Health Information Exchanges). Any LTPAC organization that is not prepared or capable of true interoperability will quickly lose patient referrals of the most desired types. Similarly, any EHR system that is not fully capable and actually delivering interoperability should be avoided in any EHR selection process.
There are many EHR systems available to LTPAC providers, but only a few are capable of and actually delivering interoperability, as defined. This is also true with the hospital systems. Most are capable of interoperability but most are not actually sharing information with LTPAC at this time. The requirements for Stage 1 and Stage 2 of Meaningful Use for hospitals do not mandate general adoption but rather a small number of transactions to satisfy the certification. As a result of this less than rigorous requirement, the hospitals have generally deferred this activity to the future.
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