Nothing is quite so pleasant in the world of Health IT than seeing an idea you have worked on brought to life to help providers and patients improve healthcare.
In May 2012, Dr. David McCallie emailed me with an idea he had been thinking about since a Bi-Partisan Center meeting raised the critical issue of patient linking across settings, just as I had been about to email him about the same idea. Between that time and HIMSS13, we conceived of the key ideas that eventually became the core CommonWell Health Alliance services: patient matching, patient linking and link management, authorization and consent, record locator services and data access brokering. But it takes more than an idea to improve care, and a much larger team worked between HIMSS13 and HIMSS14 on the governance framework and legal entity, built the core services and the integrated EHR workflows, and tested, tested, tested to make sure it all worked flawlessly.
But the most important team is the one on the ground, delivering care to patients. Starting in December, the CommonWell member organizations and RelayHealth worked to enable built-in interoperability at a number of pilot locations. These providers included the three who sat down with me at a panel session during HIMSS14: Dr. William “Tripp” Jennings, System VP and Medical Informatics Officer of Palmetto Health; Randy Williams, Director of Information Technology at Maria Parham Medical Center; and AnnMargaret McCraw, CEO of Midlands Orthopaedics.
These three are innovators in Health IT, having installed and used sophisticated EHRs to improve care delivery within the four walls of their institutions and even deploying health information exchange to improve care delivery and population health within the branded health system. Despite these efforts, they were frustrated that the electronic information within their institutions wasn’t more liquid across vendors and across practices regardless of health system affiliation. Dr. Jennings noted that “we all should have started moving in the direction of interoperability and seamless data exchange years ago.” And AnnMargaret said that even though her organization and Palmetto both have EHRs, “We’re located within blocks of one another, yet we still fax everything.”
So against the backdrop of ICD-9 to ICD-10 conversion and achieving Stage 2 of Meaningful Use, they decided to take on one more initiative: enabling CommonWell services built into the EHR technology they use. As Dr. Jennings put it, “We cannot keep pushing interoperability down the road. Inevitably it was time to join the effort and CommonWell enables us to move closer to achieving this goal.”
Within days of going live on the services, patients in the Carolinas were being enrolled in droves. Randy described how the process worked: “Our registration group registered 180 patients in the first 24 hours.” The governance and trust model requires patients to opt-in into participate in the service, but it turns out that wasn’t much of a problem, because: “Many of our patients say, ‘Wow, this is a great thing, but we thought you were already doing this.’ They’ve been expecting us to be sharing this information and our patients have been very supportive.”
And how does this impact the ultimate customers of these services, the patients? One concrete example was given by AnnMargaret. Patients of her orthopedic practice are referred by primary care providers, seen at Midlands Orthopaedics, have surgery at Palmetto Health, are seen at Midlands for follow-up care, and return back to primary care. At each stage, the carefully curated primary care record and the more specialized records in the hospital and specialty practice need to be exchanged and reconciled to make sure each setting at each step has the latest and most up to date record to provide the best care possible. Even at this early date, parts of this full loop are being automated, enabled by CommonWell services. She described getting the records electronically immediately after discharge to enable better follow-up care: “We are really excited to have received our first ever truly electronic data exchange from the hospitals for our surgery patient post-discharge.” Dr. Jennings described the other part of that process, receiving records for patients due for surgery and reconciling medications, problems and medication allergies and intolerances into the acute care record: “Having the ability to reconcile documents and patient records enables us to propagate good information instead of propagating silos.”
These are early days for the CommonWell Health Alliance pilots, but the experiences Dr. Jennings, AnnMargaret and Randy shared at the panel session should give us all great hope for the health care system we can build as we take these services nationally, enabled in a wide variety of Health IT systems in physician practices, hospitals, pharmacies, laboratories and beyond!
Arien Malec is VP of Strategy at RelayHealth and one of the initial originators and strategists of the CommonWell Health Alliance.