This diary is part two of a series; you can find part one here.
Recently I had to take my wife to the emergency room in Madison. Her vital signs were taken at the front desk, then she was taken to a hospital room. I'd been to the ER before, so they were able to simply pull the insurance information from my record. A nurse briefly attached some sensors, which fed their information directly into the computer. A short time later, she had an x-ray done; the doctor used the x-ray to rule out major problems and sent her on her way with a prescription. The ER doesn't use CPOE (Computerized Physician Order Entry) so the prescription was actually written out by hand.
A few hours later, she had an appointment at the clinic, in Oregon; again, she hadn't been there before. The nurse pulled up her chart and went through the usual routine, then the doctor came in and pulled up the x-rays that were taken at the hospital and had now been fully analyzed. She agreed with the ER doctor's recommendation, prescribed a second medicine, and transmitted it to our usual pharmacy.
One of the biggest topics in healthcare these days is information exchange, both within an organization and between organizations, both for patient care reasons and to follow new federal regulations. Follow me over the fold...
In general, there are three types of information sharing that healthcare organizations are concerned with. (Here we're speaking strictly from a technical and logistical standpoint; we'll deal with privacy concerns another time)
1) Exchanging data between applications. When using an EMR (electronic medical record), a radiologist obviously needs to see totally different things than an ER doctor. Sometimes that means seeing different data; sometimes it means seeing the same data differently. Often, the two doctors will be using different programs (which may or may not be part of the same suite); those programs need to be able to work together.
Last year, I was on-site at a women and children's clinic that had just installed our software, and one of the nurses wasn't sure how to get to the pediatrics program from the one she was in. I pointed out that she'd already opened it; because the software is designed to integrate smoothly, it appears to be one big program even though the different components are licensed separately. When the programs are part of the same suite and share a database, this obviously makes information sharing easier.
2) Exchanging data between different physical locations. The hospital and the clinic that we went to were in different cities, but were associated with the same organization and so had access to the same data. There wasn't any need to tell the ER which clinic we'd be going to so they could send over the data; it was available automatically, even though my wife had never been seen at the clinic before.
3) Exchanging information between different healthcare organizations. This can be the tough one, due to the huge number of different systems out there. To give you an idea, the EMR software I work with can exchange data with literally hundreds of other company's programs.
Aside from needing to have access to records for patients coming from elsewhere, healthcare organizations are also motivated by federal law, as the proposed rule for stage two of meaningful use sets requirements for information exchange. This is actually the subject of some controversy because it sets a minimum percentage of exchanges with other organizations that must be between different software packages; as a result, the rule as written would keep many organizations from meeting meaningful use simply because all of the healthcare organizations in their area are using the same EMR software. We'll talk more about the stage two requirements in my next healthcare log, on meaningful use.