Interoperability in Real Life

On Monday afternoon my wife was speaking with my 82 year old father-in-law, when he began speaking in word salad - not slurring his words, but clearly speaking words that made no sense.   He had no numbness or weakness, no confusion, and no change in consciousness.  After 5 minutes all symptoms resolved.

My wife called me and after hearing the history, I knew he was having a transient ischemic attack (TIA).   Given that he was stable, I recommended that we coordinate an immediate hospitalization at a site suggested by his primary care physician (PCP) rather than take an ambulance to a random nearby location.     My wife called his PCP and was given a choice of two hospitals - one with IT systems I control and one with IT systems I do not.   She drove him to the hospital that offered care coordination via interoperable IT systems.

My father-in-law has records at 3 locations - an academic medical center (home built EHR), a community hospital (Meditech), and a multi-speciality practice group affiliated with but not owned by BIDMC (Epic).

Upon arrival at the Emergency Department, he had a blood pressure of 180/90.   The physician asked - what is his baseline blood pressure and has it varied over the past 6 months?   The physician clicked on the external records link we’ve placed in Meditech and he immediately viewed my father-in-law’s blood pressures in his PCP's Epic system.  

He then asked about recently specialty care.  One click later, all this information appeared from the academic medical center.

His care was materially different because his continuous lifetime record - inpatient, outpatient and emergency department - was available without going to a separate portal or  adopting a new workflow.

Over 24 hours, he received an echocardiogram, EKG, carotid ultrasound, and MRI.   All were essentially normal and he was started on aspirin and will followup with a neurologist recommended by his PCP.  Upon discharge, he was given a meaningful use care summary and a transition of care document was sent electronically back to his PCP.

Interoperability becomes much more real when you watch your own family members experience it.    As I’ve said before, the end of paper records and data silos will happen in our lifetimes.  This will not be a problem we pass along to our children!