Various pilots are currently running to test the efficacy and accuracy of Electronic Medical Record transport between different Providers in Health Information Exchange environments. In the past obvious barriers to interoperability of EMR systems arose due to the proprietary nature of each system.
However with significant investment and prospect of incentives looming for achievement of Meaningful Use criteria, EMR vendors are achieving a degree of interoperability between their systems in several market tests, notably the Hudson Valley pilot and CurrentCare in Rhode Island.
The next barrier to HIE implementation was the method of EMR transport and the transport protocols that would be needed for communication between Providers and Healthcare Organizations. That barrier is being addressed with the publication of the Direct Project specifications on the methods of acceptable encryption and transport. The various pilots underway are utilizing email servers with either custom or legacy email endpoints coupled with certified encryption keys, provided by a central authority.
The industry is approaching another barrier although it may not be as obvious. Provider Directories and linked Provider Demographics must be accessible to an HIE. So let’s explain the challenges.
First why should there be associated Provider Demographics in a Provider Directory? In order for Providers to communicate with other unfamiliar Providers additional identifying demographic information is required. Making an identification is different than creating a verification. It requires additional pieces of information that a Provider Demographics should include.
The entire confidence of electronically communicating patient information rests on the belief and expectation that the information is going to a unique and accurate endpoint and will get to a specific Provider within a unique Organization. Patient care and legal issues demand this occurs.
Unfortunately, the typical organization’s Provider Directories contain only limited demographic information and attempt to list Providers on a regional or state-wide basis are approximately 75% accurate. That accuracy level was OK prior to EMRs. However, maintaining that level of accuracy could be the reason for any perceived failure of HIE and EMR projects.
The real problem is not one of technology but lack of cooperation on standardization of required data elements. An upcoming post will detail the differences being presented by various standards bodies and suggest a best practice for resolving the current and future demands of Provider directories and associated demographics. Our next post will detail the differences and suggest a best practice for resolving current and future demands for Provider demographic information.
The FolioMed Team
December, 2011