Dr. Robert Rowley shares three myths about health data sharing.
Since the widespread adoption of Electronic Health Records (EHR) systems by most hospitals and a majority of community physicians, the fragmented, siloed nature of a given patient’s health story has become evident.
Health data has always been fragmented, particularly before EHRs. Each hospital’s medical records department, and each community physician’s chart rack system maintained separate sets of charts on patients – all on paper, each telling a subset of the patient’s health story. Now, with the shift of health data onto electronic platforms, the overall lay of the land is little changed. Health data is still siloed in the institutions that created them. At least, though, with electronic information, there is now a pathway to linking a person’s story into something more universal and cohesive.
Tools for connecting data
This year, with the implementation of Meaningful Use Stage 2 and the 2014 certification requirements placed on EHR vendors in order to compete in the EHR Incentive (Meaningful Use) arena, there are some key pieces that can go a long way to helping exchange data between institutions. These pieces are in two areas: content and transport method.
The message content that has evolved is the definition of a Consolidated Clinical Document (C-CDA), which is a standardized XML way of creating a clinical document for a given patient that traverses all the visits, historical and current, contained in an EHR system. Meaningful Use 2 requires every vendor to support this standard, so that a C-CDA can be created on-demand – this takes the place of the historical method of copying and faxing a patient’s chart upon request by another practitioner.
The transport method also required of every EHR vendor this year is referred to as the Direct Project. This is, essentially, a standardized secure email messaging method between two places that have established a trust relationship between them. Like with email, any kind of attachment can be added to the message, such as a C-CDA. A Direct email, however, assumes that the recipient knows their own Direct address, and that the sender knows that too. As yet, there are no universal ways of looking up someone’s address in order to send a message to them – this has been discussed in more depth previously.
Is this enough?
With these two important pieces now required of every 2014 certified EHR, is this what will break down the barriers between the silos? These are important tools, but they are not the whole answer. There are some myths about health data exchange that need to be addressed in order to better see the way forward.
