Commentary: Time to look beyond EHRs to Direct messaging, natural language processing, rules engines to liberate data

While healthcare entities are waiting for EHR vendors to make data more interoperable, a raft of emerging technologies are enabling information exchange in ways that work effectively today, according to Lisa Moon, a partner with the Timmaron Group.
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EHR users are caught in a cycle of waiting and hoping that vendors quickly develop systems where data is standardized, accessible and free flowing.

Standards for healthcare data are beginning to align and, in turn, structured data is shaping up to be the gold standard.

But data still resides in the EHR, separate, siloed and often unavailable to those who are bound by duty, through role, to collect and then use information in health care delivery.

With that in mind, perhaps it’s time to look at other solutions beyond what EHRs can deliver. Especially at a time when innovative cost effective options for moving data have evolved to solve the difficult information exchange issues experienced in health care delivery operations.

One approach is to proactively leverage the real-time hospital event notifications to improve care coordination and help reduce costly re-admissions. Over 34 Million Transition of Care documents were exchanged via the Direct Protocol in Q4 2016. The exchange of these TOC’s can be leveraged as trigger events that generate other notifications to various interested parties. This manner of care coordination is the result of innovative use of the Direct Protocol in concert with other technical tools like Integration Engines, Natural Language Processing and a sophisticated rules engine normally associated with expensive and costly HIE structures. The service is designed to deliver a lightweight, scalable and sustainable solution for data exchange by innovating and reimagining the role of a HISP.

There are many benefits to this approach. It is easy and quick to implement. In Carlton County, for instance, 35,000 citizens will be covered in an Event Notification System powered by an innovative Direct solution. Funded by the State Innovation Model demonstration, Direct protocol will be used to identify high risk patients and whenever a CCD with one of those patients is exchanged the processing HISP automatically generates additional notifications to all community partners involved with managing that patient’s care. In this demonstration, a TOC that was originally sent to a PCP will be the trigger to send additional customized notices to a LTC facility, a specialist or multiple specialists or even to the patient themselves.

What is important to note is this approach does not require more coding and database changes to the hospitals EMRs or any further collaboration by the EMR vendors. Instead, it leverages innovative Direct products.

The CDA document is a standardized Structured Data Payload. The amount of data contained in a CCD has been a problem, often overwhelming the receiver of that document and rendering it useless. This again can be solved to make the data more accessible and actionable by customizing a payload to the needs of the receiving party.

These actions to transform data are taken on while data is in motion to deliver a customized summary alongside the complete CCD. This approach directly addresses the costs and concerns of HIE models which are still struggling to find sustainability. But most importantly it demonstrates that healthcare providers can free the data without having to wait on EHR vendors – by simply redefining the functions of a HISP.

Data is a strategic asset. EHR vendors have little economic motivation to share data. Their business model is built upon multiple revenue streams including fees associated with charging for patient data. Until that model changes health care organizations, providers and collaboratives who rely on data for insights will be at a disadvantage.

Fortunately, new products are developing and a significant amount of progress has been made throughout the industry in the past few years.

Seamless and ubiquitous health data needed at the point of care, however, is still an evolving concept and one that the health care delivery system cannot rely solely on EHR vendors to solve.

Lisa Moon, partner in care management and applied informatics with Timmaron Group, is also a PhD candidate in nursing information science and a former public health official. 

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