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Folding health information exchange into relevant clinical practice

Health information exchange must move beyond data repositories and be searchable, useful content for physicians, says Jonathan Gold, regional CMIO.

Information exchange is not just about establishing a repository of static data that sits and waits for people to access it. Instead, clinicians and health IT experts are considering ways to turn data into actionable, meaningful information that can be used to create individualized patient treatment plans while fostering heightened awareness of the health of patient populations.

Jonathan GoldJonathan Gold

One way to ensure health information exchanges (HIEs) become these types of vibrant networks is to utilize and leverage search engine power. By harnessing the intuitive nature of algorithms like those of Google, Bing and Watson, health IT leaders have the opportunity to transform how clinicians investigate patient conditions, and determine diagnosis and treatments.

The use of electronic health records and mandates through the HITECH Act all support the increased sharing of patient information through HIEs. But what will it take to develop an environment in which information sharing thrives? Physician Jonathan Gold, regional chief medical informatics officer (CMIO) for Catholic Health Initiatives, who is presenting this topic during the iHT2 health IT summit in Denver, discusses his vision for organizing information and developing physician workflow in this interview with SearchHealthIT.

What does information exchange mean to an organization with as much breadth as Catholic Health Initiatives? How do you organize information across settings, and is there time/room after that to consider how to exchange information outside the organization?

Jonathan Gold: We made a strategic plan a number of years ago to set up a health information exchange. This plan will include all our health care facilities across CHI's 19 different states. Each state has different rules/regulations about what can be shared, and it adds a layer of complexity for exchanging medical information across the organization.

We are going live in January 2013 at our first pilot sites, and then will roll out the exchange to our remaining facilities. We have a centralized server for sharing information; that is, data from a clinic or hospital will be uploaded to our data repository, which will be located in Denver. This will help speed up the process for accessing information at the point of care.

What role do search functions play within HIEs? Do you believe that someday HIEs will have their own search engines that work like Google?

Gold: Yes, absolutely. Our thinking about HIEs must go beyond viewing them as repositories of aggregated paper records. We need to focus on giving the clinician information at the point of care. In short order, we will want to tap into that power of information and actually apply what has happened in a large group of patients to specific patients.

The secondary use of medical data will empower the clinician to receive decision support tailored to a patient's particular medical characteristics. For example, a physician might query 'How many people in this database have a specific set of similar qualities.' From there, he or she might be able to drill down to questions targeted at choices about treatment for that specific patient by asking things like, 'Well what happened to similar patients when they took Drug A or Drug B?'

More customized care for patients is a major goal of clinical research. How do HIEs fit into that goal? Who should be able to obtain and use information through exchanges? What are the privacy and access issues that must be addressed to ensure information is used accurately?

Gold: A patient's right to privacy remains crucial. Clinical information that is meaningful and helpful for other patients must not harm the privacy of the patients who have allowed access to their records in an effort to advance research and help others. If we can share statistics about groups of patients in the database with the providers similar to those examined or treated at the point of care, we can enable the doctor to make more rational decisions for their patients.

You've spent a lot of time helping to develop workflows, physician systems and EHR functionalities. As more exchange and search tools are developed, how will physicians find time to use them?

Gold: Doctors and other medical staff work in three different modes when it comes to diagnosing patients and understanding their conditions. First, they might recognize a pattern in its entirety for very common illnesses in the context of very common situations. Second, providers might feel comfortable that a pattern looks familiar, but there seem to be enough odd pieces in the puzzle that they should investigate what is happening (through diagnostic tests) in order to validate their thoughts. Last, they might not recognize any clear pattern of signs and symptoms and think, 'I don’t know what is going on with my patient and I need to approach this logically.'

For simple things (sore throats, etc.) doctors might do a culture and send the patient home with a prescription. Physicians will probably not need to do a deep investigative diagnostic dive -- they've seen this pattern often. Often, though, the pattern is not so clear or the patient has multiple chronic diseases and is receiving many medications. The clinician will need to look at the literature or talk with his or her peers.

That is the type of a situation where I see us searching the data in the HIE. Physicians who want more information to help guide them with their more complicated patients or who have a diagnosis but want to know the best treatment for complicated patients, taking into account their specific myriad of diagnoses and medications.

Dr. Jonathan Gold is a board-certified pediatrician with 15 years hospital and ambulatory care experience. He serves as regional chief medical informatics officer for Catholic Health Initiatives, the nation's third-largest Catholic health care system. He co-leads CHI's Health Information Exchange program, Clinical Portal and Patient Portal.

Previously Dr. Gold served as the physician development analyst for two major vendors, contributing subject matter expertise and assisting in medical application development, adding decision support and content to the electronic patient record and computerized physician order entry application, and meeting CCHIT requirements.

In 2006, Dr. Gold completed a National Library of Medicine post-doctoral fellowship in health sciences informatics at Johns Hopkins University School of Medicine in Baltimore. At Hopkins, he received both a master of science in health sciences informatics and a post-master’s certificate in information technology and telecommunications.

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