Healthcare provider directories that could facilitate the exchange of patient data were discussed at this week’s HIT Policy Committee Information Exchange Workgroup meeting.
To better envision exactly what the directories should look like, along with which organizations would be allowed in, who would do the admitting and what some business models could look like, workgroup member Walter Suarez, M.D., MPH., described a number of possible use cases. Two of those specifically related to hospitals.
In the first such scenario, a hospital discharge summary, (i.e. CDA) is sent from one hospital information system (EHR) to the clinic EHR where the patient’s primary care provider practices. The clinic’s EHR receives the discharge summary, incorporates the data, and sends an alert to the primary care provider.
According to Suarez — Director of Health IT Strategy & Policy with Kaiser Permanente, and a member of the Health IT Standards Committee — the directory would allow the hospital to identify the organization-level ‘address’ of the clinic, along with other information-exchange features it supported. Information in the message header or inside the message would be used by the EHR of the recipient to incorporate data and issue relevant alerts. Also, using the directory, the digital credentials of both the sending and receiving computers could validate identities.
In the second scenario, an individual from Boston falls ill while on vacation in Florida and must be admitted to the hospital. To deliver optimal care, the hospital in Florida needs information from the hospital in Boston (specifically the patient’s CCD summary). In this case, the patient knows the familiar name of his Boston hospital, but that is insufficient for sending the query. Leveraging the entity-level directory, the Florida hospital is able to get the exact “address” of the Boston hospital, send a query, and receive the summary.
While the scenarios were detailed, many of the program’s specifics were not. For example, the workgroup still had to determine whether it would recommend a federated or centralized model, whether there would be one entity-level directory for the country controlled by one organization or one entity-level directory managed by the states or even multiple HIOs within each state.
Paul Egerman, software entrepreneur and member of the HIT Policy Committee, suggested the Internet could serve as a model. “Perhaps the statewide HIEs or HIOs could act as registrants — in such a way you would have national access to all information and also, as a result, downloadable copies if people want to use that in their EHR systems. I suggest a national approach that is not centralized,” he said.
Jonah Frohlich — deputy secretary, HIT, California Health and Human Services Agency, and a member of the workgroup — said the group will have to arrive at recommendations about which organizations can apply for entry into the directories and who will ultimately govern the admittance process. “To me, a lot of those activities are interrelated, so having many of those occur at the state level with the HIOs could make a lot of sense.”
Egerman cautioned that one outcome the group should avoid is a policy that forces healthcare organizations to participate in multiple entity-level directories, for example requiring them to register in each state where they have a significant number of patients. For some hospitals and health systems, such as those in Rhode Island and Delaware, he said, that could be as high as four or five.
The meeting concluded before one of the most critical issues — business models that offered financial sustainability — could be discussed. That issue will be tackled at a future meeting. Added Frohlich, “We can look at directory services inside and outside healthcare to see what could be a sustaining model.”