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Jun 21 2012   9:55AM GMT

The two words that will unlock health care interoperability

Posted by: Jenny Laurello
health information exchange, HIE, Interoperability, Meaningful use, meaningful use stage 2, MU, MU stage 2, Stage 2

Guest post by: Ruby Raley, Director, Healthcare Solutions, Axway

The ONC’s Farzad Mostashari M.D. made a powerful statement at the Direct Project meeting this year, and it’s been resonating with me ever since.

“Two words,” he said, “will unlock interoperability: Stage 2.”

40% of the proposed objectives for qualifying for incentive funds for meaningful use Stage 2 are related to the exchange of health records — health information exchange (HIE) — with others.

Yet when it comes to HIEs, I detect a lot of fear, uncertainty and doubt (FUD) from health care providers in the field, and I think it’s because we’ve somehow mixed two different use cases — “push” and “pull” — into one terminology.

“Push” happens after an episode of treatment in an effort to coordinate care, facilitate payment and inform public health authorities of any developments. Providers push clinical, operational and payment data — e.g., continuity of care documents (CCDs), lab results, admission, discharge and transfers (ADTs) — to other specialists, primary care physicians, public health agencies or HIEs to inform them about the care a patient has received.

It’s a point-to-point construct, a classic messaging scenario with a sender, receiver and payload. A provider can easily record the message’s intended recipient, clarify its purpose and receive delivery confirmation, all while minimizing consent and privacy issues because the patient explicitly authorized this transaction in their HIPAA release.

But “pull” typically happens before an episode of treatment, and unlike “push,” the provider doesn’t know much about the patient yet, so the provider is pulling data from repositories, looking into the HIE to do research and discovering critical information — lab results, medications, history and more — that’s necessary for providing care.

What ensues is much more conversational than in “push.” A “pull” transaction may go something like this:

Provider: “Do you know this patient?”

Repository: “Perhaps. Here is a list of patients similar to the one you’re inquiring about.”

Provider: “That one. The fifteenth one down. That’s the one I want to learn about.”

Repository: “Are you authorized to learn about this patient?”

Repository: “Yes. Here is the patient’s HIPAA release. They have opted into data sharing in the HIE.”

Provider: “Thank you. ┬áPlease send me their information.”

The classic, real world example of this transaction takes place in the emergency room: an incapacitated patient arrives and the caregivers consult the HIE to learn more about them before they render treatment.

Another example: a patient visits a doctor who then asks for a lab test recently ordered by one of the patient’s other doctors, and thanks to “pull,” the doctor can procure the results of that lab test with nothing more than the patient’s permission.

Mostashari was spot on in that stage 2 will unlock interoperability.

It will move us closer to, as the National Partnership for Women & Families says, “the information-rich, patient centered health care system that we all desire.”

But it’s up to health care providers to recognize the unique features of stage 2’s different use cases and to put them to use for their patients.

Only once they do that — once they squarely relegate fear, uncertainty and doubt to the past — will stage 2’s true potential be realized.

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