Thursday, March 6, 2008

Cool Technology of the Week

This week, the Massachusetts Health Information Exchange, MA-SHARE, went live with secure sharing of clinical summary records from provider to provider at Beth Israel Deaconess Medical Center, Lahey Clinic, Northeast Health Systems and Boston Children's using the recently recognized national standards harmonized by HITSP.

Here's how it works.

When a patient registers for care, their primary care giver is captured by the registration clerk. We store the National Provider Indentifier of the clinician.

When a patient is discharged from the hospital or the emergency department, a comprehensive clinical summary is automatically prepared in Continuity of Care Document format including medications, diagnoses, procedures, and all followup issues.

This electronic document is sent via SOAP/HTTPS to a hospital-hosted gateway. That gateway uses the National Provider Identifier to look up the primary care giver's institutional affiliation in our statewide provider index. The summary is then routed to the gateway of the receiving institution via the internet via SOAP/HTTPS. Once it arrives, it is routed to the clinician's Electronic Health Record, Fax machine, or secure Email box.

The end result is that we are ensuring appropriate followup, medication reconciliation, and communication among physicians using a standards-based electronic document and the internet. Further details are available in this overview.

In Masssachusetts, we exchange 100 million HIPAA transactions per year via our New England Health EDI Network (NEHEN) gateway. Massachusetts was recently recognized as the #1 e-Prescriber in the country and part of our accelerated adoption has been our use of an e-Prescribing Gateway. Now the secure summary exchange gateway is live. All three of these gateways are built on the same application platform, which is running at hospital systems and payers throughout the state. There are no transaction fees, and no charges to the patient. The software is developed and maintained via contributions from provider and payer organizations which derive value from its use. In the case of secure document exchange, we can eliminate mailing discharge summaries and ED notes, saving hospitals like BIDMC $100,000 per year.

National standards, the internet, and a business model for health information exchange in production. That's cool!


davet said...

Does the physicians office then match the patient record from the hospital with a record in their system, or is there a patient identifier that somehow is sent from the physician to hospital?

John Halamka said...

We've elected not to try to maintain a community master patient index. The physician attaches the summary to the right patient in their EHR.

Adrian Gropper said...

Now that there's a digital document, how does the patient see a copy of the clinical summary that's being sent via email?

Unknown said...

I was expecting commentary on the iPhone SDk :(

Good read though, very interesting.

John Halamka said...

Per Adrian's question - at present, the patient receives a printed human readable copy of the CCD document at discharge.

Adrian Gropper said...

A printed discharge document is also what Minute Clinic provides to the patient. This prompted a brief comparison on my blog.

Chris said...

How do you think this compares with a consumer-owned model of data sharing like Google Health? Is this an alternative or complementary approach?

John Halamka said...

It's complementary. We also a pilot participant in Google Health, so patients will be able to be stewards of their own records in addition to this provider/provider exchange

Adrian Gropper said...

"stewards of their own records" is vague from a privacy perspective. One might say the policy enforcer is the steward. In one case, Google is clearly the steward. In the other, NEHEN is the steward. How does the patient control what records are available through NEHEN? Will I be able to accept Google and reject NEHEN?

John Halamka said...

In the case of Google, the patient is clearly the steward because they gather the data from sources, apply privacy flags, and then transmit the data to others as they wish. No data flows without the patient taking action.

In the case of MA-Share/NEHEN, it's an opt in consent to send the summary to the next provider of care. The patient can say no.

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