An interoperability breakthrough?

In what some are calling a major technological breakthrough for EHR interoperability, Carequality and CommonWell are set to launch a health information exchange that will include all major EHR vendors.

Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative, sat down with Medical Economics to answer questions about what to expect, how to cope with the additional data, and what lies ahead.

Medical Economics: When will this be available to U.S. physicians and how do they get on board?

Micky Tripathi: We already have some provider organizations in initial production connected via Cerner, Greenway, and Epic, so some physicians are already using this.

By early October, it will be opened up completely to all CommonWell and Carequality vendors. The bridge is built, now we just need vendors to make it available to their customers. We expect that in eighteen months to two years, most vendors will have implemented it with their customers.

ME: How many US physicians will be able to make use of this?

Tripathi: The EHR vendors in Carequality and CommonWell represent about 75 percent to 80 percent of U.S. physicians. I suspect and hope! that as word gets out, physicians will be banging on the door, asking their vendors: “When do I get this?”

ME: More interoperability means more data for physicians to digest. Won’t physicians be flooded with data?

Tripathi: This is one of the challenges of interoperability, but it’s the problem we wanted to have.

I’d rather that people complain about the data they’re getting than get no data at all. However, I realize that physicians can be inundated by too much info, which presents workflow and safety issues as well. Vendors are working with their customers to integrate all this data into their workflow-what fields doctors need to be able to access from which screen, what data they can do without, and so on.

But in order to make this work for you, there is no better channel than loud and frequent feedback to vendors. The more focused feedback you provide, the more they respond.

ME: Is there something that physicians can do on their end to help them sort through the tsunami?

Tripathi: Physicians need to think: “How I am going to use this data? What data do I really need?”

The practice manager, physician manager, or care teams need to look at this in a thoughtful way, see how they can make the best use of it, and set up processes and routines for managing the day-to-day flow It’s no different than what they’ve already put in place with their postal mail, courier packages, and faxes – it’s just another medium.

ME: What types of information will doctors be able to access beyond Continuity of Care Documents?

Tripathi: Right now all you get is the Continuity of Care Document, which has 22 data elements required by Medicare and Medicaid.

Physicians say, “The CCD! You’re giving me more of the stuff I hate!” For many physicians CCDs seem like 10-15 pages of cut and pasted information with one small piece that they need hiding in there somewhere. I’m sympathetic to these concerns, but once this data is in their system, they can figure out how they want to integrate it into their workflow.

Most physicians can tell you the three or four other clinicians or specialty groups they need information from regularly, and usually three or four types of info they need. They should communicate with their main referral partners to get and set expectations of what they will send and receive through their EHR systems. They can say establish workflows for handling information from their main referral partners, which will account for most of their activity, and a triage process for managing the less frequent, ad hoc information that dribbles in less frequently.

Again, they already do this with their paper processes, they just need to apply that same attention on process to their electronic processes.

ME: So what is the long-term picture?

Tripathi: Over the next few years we should see more functions based on FHIR standards which will provide the ability for more useful interoperability because the data will be more manageable.

The CCD is a document-level standard, meaning that you get the entire medical document with each exchange, not just the specific information (like medications) that you were looking for. FHIR is a data-level standard, meaning that you can ask for and receive specific information (like medications) and just get that back. It’s basically the same technical approach that Amazon and other modern platform companies use today.

Here’s an analogy. Way back in 1998, Sears had a shopping website, but in order to use it you had to download the whole Sears catalog, page through on your computer it to find what you want to buy, and type the information into a box on the Sears website. Now you go to Sears or Amazon and type “21-inch gasoline lawnmower,” and it gives you back just the information that you asked for, not their entire catalog.

ME: So now we’re at the 1998 Sears website stage?

Tripathi: Right. Is it perfect and elegant? Absolutely not. But we have to start somewhere. We’ll look back in ten years and see that this was the first step toward nationwide interoperability-like the old online Sears catalog. But by then we’ll hopefully have something more like Amazon.