Wednesday, January 8, 2014

The Next Phase of Healthcare Information Exchange

Today, Massachusetts Governor Deval Patrick will launch the next phase of healthcare information exchange (HIE) in Massachusetts - “Commonwealth Interconnected:  Mass HIway Query and Retrieve

In Phase 1 of our state HIE project, we focused on the Meaningful Use Stage 2 Direct protocol, enabling transition of care summaries, public health reporting transactions, and labs to flow over a state operated secure infrastructure.

In Phase 2, we solved a much harder and more complex problem - the pulling of records in real time from physician offices and hospitals where patients have opted in to disclose their records to other caregivers.

This required the engineering of several components
*A state wide master patient index for patients who opt in, storing name, gender, date of birth and other demographic data elements
*A state wide consent registry indicating the medical record numbers and locations where patients have opted in to disclose their data to caregivers
*A portal which enables providers to securely login and view patient medical record locations
*A viewer which enables secure retrieval of medical records from organizations which support real time data display
*An electronic medical record request system for those organizations which support a request/release by the medical records department workflow.
*Full audit trails of all activity - an accounting of disclosures

Today a multi-organizational team will demonstrate an Emergency Department visit by a febrile, confused, elderly gentleman.   His records are scattered over many hospitals and clinician offices.   Treatment in an emergency room is accelerated, more aligned with patient/family care preferences, and is safer with more information.   We'll demonstrate how a single institutional record based on one episodic visit can be very different than a lifetime continuous record which includes the entire patient experience with healthcare.     We'll show several near misses with diagnostics and therapy that could have caused harm, increased expense and reduced quality.

Today is the launch of the service.   The state's master patient index and consent registry (collectively called the relationship locator service) will be populated as patients consent to be included.   57 organizations including providers, public health, health plans, local HIEs and clinical registries are already part of the Massachusetts HiWay and all will be working hard in 2014 to expand the use of the new services.

I can imagine a day in the next few years, when all patients in the Commonwealth, with their consent, benefit from secure, coordinated care.    My mother suffered a major medical error in California because of inaccessible primary care records.   I truly believe that my 20 year old daughter, attending Tufts University, will see significant reduction in preventable harm in Massachusetts during her 20's.

Let the safety begin!


Chester Eastside said...

So what happens when a patient moves to another state? Travels to NYC for specialized care? Mobile patients and providers defeat the underlying premise of localized HIE, such as in MA.

jcavery said...

This sounds like it will also benefit the IT industry due to required training, software, and better hardware. Lots of jobs will be created to support this system and hopefully get more efficient as more people use it.

Elder Granger MD, Major General US Army Retired said...

MA will be the first state in my opinion to document a significant decrease in medical errors, improved patient safety, and clinical outcomes as well as decrease cost as more patients opt-in.

Elder Granger

Mark said...


Can you recommend a good resource for learning more about CCR/CCD definitions and standards?

Best regards,