The healthcare industry has a poor track record of facilitating the integration of Patient Information.
A patient can be receiving services from a General Practitioner, a Specialist, and one or more hospitals.
Rule #1 within any single healthcare services delivery entity is a record of each patient encounter/ service performed needs to go into the patient EMR.
The reason is simple – in the absence of being able to reach anyone who knows the Patient History, a provider has to rely on what is in the EMR for decision-making relating to the Patient.
Clearly, when a Patient is receiving services from more than one healthcare facility, there is a need to consolidate encounter information to avoid duplication of services and reduce medical errors.
How to Route encounter information to patient EMRs
Most healthcare organizations have best practice protocols and if the nature of service deliveries to patients involves the receipt of services from multiple providers (internal or external), it is essential to have best practices in-line (not online, not offline).
Providers are simply too busy to look up information.
But, they are trained to consult “the Chart” and can be relied upon to do so, if they are given easy access to it.
“In line” means there is an RALB (Resource Allocation, Leveling and Balancing) environment that provides orchestration plus governance (i.e. taking care of what, who, why, where and when).
Orchestration comes from background BPM (Business Process Management) best practice flowgraph templates (i.e. the system automatically posts steps to user InTrays for attention/action and when one step along a patient care path is committed, the next-in-line step posts automatically to the attention of staff who have the requisite skills to perform such steps).
As each step is committed, a recording is made in the patient EMR (i.e. data, as it was, at the time it was recorded, on the form versions that were in service at that time).
Whereas best practices are “best” most of the time, each patient is different. The number of permutations and combinations of possible interventions is too vast to expect all eventualities to be covered by best practice templates.
Providers often need to skip steps, perform steps in a different sequence, insert steps not in any template, re-visit already committed steps and record data at steps that are not yet current. Rule sets are needed to “rein in” extreme variations away from best practices. As with BPM, the underlying methodology , ACM (Adaptive Case Management), in this case, needs to sit in the background.
It is common practice for healthcare professionals to discuss “next steps” for patients and healthcare professionals need easy ways to do this.
Time does not always permit telephone conversations or face-to-face meetings.
The best solutions are Instant Messaging (IM) and secure Point-of-Service (POS) e-mail.
IM clearly is the best approach but it is only “instant” if the sender and receiver are both logged into the software environment at the same time. Otherwise, “instant” could be hours or even days.
POS is an extremely attractive option because each outgoing message is situational/ context appropriate. If your current focus is to carry out a diagnostic assessment and you either have a question or are looking for a “second opinion”, the ideal scenario is to be able to send out a message from the diagnostic assessment step and get back a response at the diagnostic assessment step.
The benefit of POS messaging is you don’t have to provide a lot of information – many times “take a look and give me your opinion” will be sufficient because the software system has a direct link to the patient\pathway\step. All the recipient of a POS message needs to do is log in and he/she will see the step that is the focus of the POS e-mail.
It’s important to point out that in any 24×7 organization, a healthcare professional may ask a question, and then go off shift.
No point for the recipient of an e-mail message to send a response back to the healthcare professional, the message clearly needs to go to the POS (i.e. the process step of focus) so that a night shift healthcare professional who may have seen neither the request nor the response, will be able to see both and take appropriate action.
POS messaging can be important even for organizations that run one shift because handoffs are frequent.
A final “must have” capability for Continuity of Care is the ability for any healthcare entity to update Patient EMRs with data from other healthcare service delivery organizations patients may be dealing with.
Here, an e-hub is the best solution.
There is no reason why we should not today have patient data transparency, but the healthcare industry has been preoccupied with details relating to message formats as opposed to embracing the concept of generic data exchangers where publishers and subscribers can each read/write data using their own native data element names.
There is no need to standardize on EMR systems or on data transport formats.
e-Hubs of the type designed by CHM of California accommodate data consolidation from any number of clinics, hospitals, labs and distribution of encounter information on a need-to-know basis for import to healthcare service provider patient EMRs.
Isn’t it time healthcare joined the 21st century?