Wednesday, June 25, 2014

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!


Zia said...

Thanks for sharing this story. I hope that your father-in-law recovers fully.

May I ask who built the interfaces between Meditech-Epic etc.?

Lately, I have been trying to understand the issues / causes for the apparent failure of integrating the Military Hospital System EMR / EHR and the VA Systems EMR / EHR. Perhaps you have some pointers or insights to share ...

Catherine Rose said...

Dr Halamka, Thank you for posting this real-life story (and a personal one). Even our own car dealerships have the ability to pull up records on cars easier than most hospitals -- when lives are in the balance. I'm happy for your your father is recovering and received excellent care! Based on my experience with my daughter (paper medical records and disjointed care), I'm happy to hear great minds like yours are working to solve some of the toughest problems! -Catherine Rose

Kiran said...

What a great story, John. Glad this had a happy ending. We had the converse experience with my father-in-law this weekend where he experienced a fall that turned out to be an angina attack. None of his records were electronic. We were very fortunate that the family was able to piece together his previous medical history but we were aware at every step how real the risk was. Easy to lose sight of what something really means till you have to live it.

John Halamka said...

For the details on how we integrated Epic, Meditech, and other systems, see

Another Shade of Blue Button

Anonymous said...

Could you share how his care was changed by the treating clinical team having access to this data? Specifically, were different tests ordered, different decisions made, a different care plan pursued than you would expect with this clinical presentation due to having this prior data available?



Keith W. Boone said...

Or our parents...

Tina said...

Happy to see Interoperability in a real world experience with positive outcome.Thank you for sharing.