We are at the end of the last reporting period for Stage 2 of meaningful use for hospitals and the beginning of the last reporting period for physician practices. However, it appears that the post-acute care industry has been stuck with the task of figuring out what to do with the data and information that we’re creating and how to add their input to all the information that should be moving around.
Members of our organization have been meeting on a regular basis with our post-acute-care partners, including nursing homes, home care agencies, rehabilitation facilities and other providers. Each needs the information we’ve gathered on the health of the patients we have in common. The primary question is, how do we best share that information? Is it via printed inpatient medical records, fax, standard forms or some other approach? Given a choice, I’d vote for “some other approach.”
I’ve also had many conversations with local physicians who have implemented electronic health records in their offices, seeking a solution to the growing requirements to be “connected” so we can exchange information about our shared patients. Unfortunately, we’ve been working only on ways to pass what some believe is the appropriate clinical information from one setting of care to another. It’s a start, but most physicians say they don’t get much clinical value out of those documents. What they really need are approaches that enable them to share their information with the hospitals and other care providers without requiring additional work on their part.
Consider a standard history and physical (H&P), which is required for every hospital admission. In most cases, if the patient is in the physician’s office and the physician has determined that the patient needs to be admitted to the hospital, they have already captured and entered into their office EHR all the information that will become the content for the H&P.
Some physician practices are creating the H&P in their office EHRs and faxing them to the hospital; that works for the physician and the office, but not for the hospital. Wouldn’t it be better to have some standard document structure that would enable physicians to incorporate the information from their office EHR and securely send it electronically to the hospital or other care provider?
We’re not just lacking an appropriate highway for this information in many areas of the country; we’re also missing the target for which information should be moved, and how it should be done.
Several initiatives are in the works that might help in this area; one is the final rule setting the 2015 payment rates for skilled-nursing facilities. Within that rule, the federal government restates a commitment to accelerate the use of health information exchange in the skilled-nursing sector; however, the rule sheds very little light on how the industry should accomplish this.
In our care delivery region, if we can get the highway constructed, there are many bright people who have a vested interest in getting this moving and getting it right. We would prefer not to create a one-off solution for this region, but if that is what it takes to improve information exchange in a manner that positively affects care and removes manual work, I will probably head toward that light.
If anyone has already started paving this dirt road with a defined standard that would work across a broad scope of defined document types and information content, please let me know at [email protected].
I doubt we’re the only ones looking to solve this dilemma. Before we get too far down the path in digitizing information, we need some forethought to facilitate what will become an increasingly common requirement for data exchange.
Charles Christian is vice president and chief information officer at St. Francis Hospital, Columbus, Ga.
