Promised health records exchange faces rough road to reality

A hodgepodge of data standards and a fractured network means digital medical records simply aren't very portable

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The company that built it, Harris Healthcare Solutions, hopes that over time it will become a de facto national HIE, creating a center of gravity that EHR vendors adapt to, says Dr. Vishal Agrawal, Harris Healthcare's CEO. Separately, a few years ago the VA and Kaiser Permanente -- the largest medical provider that acts as its own insurer -- began working on a common interchange system, as the two organizations were the pioneers in EHRs and have significant patient overlap.

In the meantime, Agrawal says, there are two models that can be used in today's more locally oriented health data exchange -- that is, between providers in the same town or area, which is the geographic range of most patients' care.

  • Unified view: Just as an iPhone, BlackBerry, or Android device can show a unified email inbox drawing from separate email accounts, so can EHRs. Instead of exchanging data across multiple systems to keep records complete and updated, this approach pulls the separate data into a metalayer that assembles a common view. Thus, providers can see a master record though one doesn't actually exist. As with email, each "account" resides only with that provider. This approach works when just a few entities are involved, Agrawal says, due to the communications overhead of a real-time pull from all sources. He suggests it to providers with remote clinics, so those clinics don't have to carry the massive data storage of the main hospital.
  • Replicated data: Although the numbers are declining, it's still common for private physicians to affiliate with one or more hospitals when treating patients for specialty issues. Such small shops can't afford massive EHR systems but need access to the central EHR data for specific patients, and their treatments tend to be unrelated to the rest of the care given the patient. Replicating the data to such providers as needed and replicating the data on their treatments back to the main hospital makes sense, Agrawal says. "Of course, this approach can't be immediate. But most information [in this scenario] is not urgent, so that's OK."

What doesn't work is the notion of a master database, says Agrawal. There's simply no way to have one repository of a patient's medical records that all providers can access and update. The U.S. legal framework doesn't support it, and such a massive database would be, to put it mildly, a very tough technical challenge to build, run, and maintain.

Blue Button to the rescue?
The feds seem to be encouraging a common health information standard by promoting the VA's Blue Button effort, which provides a download format for a patient's entire medical record. The successor Blue Button Plus adds a human-readable requirement and a standard for the information transmission. Blue Button Pus is not mandated by the Health and Human Services Department's Office of the National Coordinator (ONC), which sets the rules on EHRs and so-called patient engagement standards.

But it's clear that the feds are suggesting it as a common platform for the health care industry to adopt, given that the industry has yet to do so on its own. EHR providers are now beginning to incorporate Blue Button Plus, but most insurers and many health care providers have not come on board, says Greenway's Barnes. "The Big Blue Button download becomes the common conduit," says GE Health's Steinman, "but there are still too many export standards right now. It's like financial services 10 years ago."

This article, "Promised health records exchange faces rough road to reality," was originally published at InfoWorld.com. Read more of Galen Gruman's Smart User blog. For the latest business technology news, follow InfoWorld.com on Twitter.

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