Like many complex healthcare systems, BIDMC does not have a one size fits all solution for ambulatory records. Although we favor integrated systems, we need to achieve interoperability via interfaces between two EHRs - a home built web-based product called webOMR and a commercial hosted version of eClinicalWorks.

Prioritizing our interoperability efforts to improve clinician workflow, enhance the quality of care delivered, and adhere to multiple federal and state initiatives requires extensive planning with many stakeholders. Here is our vision:

In January of 2010, the Federal Notice of Proposed Rulemaking on Meaningful Use will outline the data exchanges we must perform and the timeline to perform them. The 2011 exchanges are anticipated to be:

Lab results delivery (true integration)
ePrescribing
Claims and eligibility checking
Quality & immunization reporting
Registry reporting and reporting to public health
Health summaries for continuity of care
Populate PHRs

Here's our plan.

webOMR is an integrated system which is perfect for clinicians who order all their laboratories and radiology tests from BIDMC. It is not ideal for community clinicians with limited BIDMC interactions. For BIDMC-centric practices, lab results are already truly integrated with BIDMC lab. e-Prescribing is already live. Claims/eligibility/administration transactions are already live. We have begun a $500,000 Quality Registry reporting project, and have committed to a Boston Public Health Commission Public Health Reporting project. We will implement immunization registry reporting once a public entity is able to receive such data. We have already integrated webOMR into our tethered PHR (Patientsite), Google Health, and Microsoft Healthvault. We have already built outbound BIDMC discharge worksheets into eCW. We have already made webOMR data viewable inside eCW via the Magic Button pop up viewer. What remains to be done is that currently webOMR has no way to view eCW patient summaries.

eCW is a commercial EHR which is perfect for community clinicians who need to interact with non-BIDMC hospitals. eCW has already been integrated with Quest and soon with Needham. It is capable of receiving other lab feeds such as Milton or Caritas, as soon as those organizations provide outbound interfaces. e-Prescribing is already live. Claims/eligibility/administration transactions are already live. We have begun a $500,000 Quality Registry reporting project. We will implement immunization registry reporting once a public entity is able to receive such data. eCW has a patient portal that will go live in Spring 2010. We have already enabled eCW to receive clinical summaries from outside EHRs. What remains to be done? There is not a current timeline to interface eCW to public health reporting, but this must be done by 2011 if the public health entity is able to receive such data. There is not a current timeline to send clinical summaries between eCW and webOMR, but this also must be done by 2011.

Our next planning priority is to work with stakeholders to define the workflow and process needed to exchange eCW clinical summaries with webOMR. We will then meet with eCW to determine how to achieve this technically.

Thus, as you can see, we achieved a degree of interoperability that meets meaningful use criteria. We commit to have a plan and timeline in place for eCW to webOMR clinician summary transmission to complete our interoperability efforts. Will it meet all clinician needs? Many of them. Will it meet all their expectations? Probably not. We are still years away from being able to exchange the entire medical record between systems in the same way we can transport our cell phone numbers between carriers. It will be a journey. We'll start with the meaningful use transactions. We'll move from unstructured to vocabulary controlled structured data elements. True "end to end" point of origin to point of use interoperability across different EHRs will take years. I will do my best to educate our clinicians and move us forward continuously toward the nirvana of complete interoperability they seek.

John Halamka, MD, blogs regularly at Life As a Healthcare CIO.