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Curbside Consult with Dr. Jayne 4/11/11

April 11, 2011 Dr. Jayne 4 Comments

There’s been lots of buzz this week about the Care Connectivity Consortium. This initiative by Geisinger Health System, Kaiser Permanente, Mayo Clinic, Intermountain Healthcare, and Group Health Cooperative has been noted everywhere from The New York Times to Yahoo and MSN.

I can’t wait to see how this collaboration unfolds. Those of us who have spent the last several years knee-deep in Health Information Exchange know how difficult it can be to actually make this happen.

I’m interested in seeing details on the pre-work: consent, governance, and ownership. It’s challenging enough to get a productive HIE live that meets the legal hurdles of a single state, let alone meeting those of a disparate group covering Pennsylvania, California, Minnesota, Utah, and Washington (which just represent the headquarters states, not all the states where care is delivered, which will also have to be addressed).

The warm and fuzzy scenario presented in The New York Times piece: “A person walks into a clinic in Phoenix, say, and, with permission, her records from her hometown physician’s office in San Francisco are efficiently summoned with a mouse-click.” If only it were that easy!

Having been involved with attempts to jumpstart a regional HIE, I know that wading through the legalese for the patient consent and trying to fit it on a single page reminded me of the scene in the cult classic The Princess Bride, where the bad guy has a machine that sucks years of your life away.

The consent language for many data exchange projects can be nearly unintelligible for the lay person. I suspect the forms will become “just another form” that patients shuffle through and sign if they want to receive care, whether they understand it or not.

(Kind of like the paperwork in the Emergency Department – do they think patients actually read that? I don’t think so. They sign it because they are sick, hurting, and in need of care. When you just want to see your doctor, you don’t care about the HIPAA Notice of Privacy Practices, Patient Financial Responsibility statement, or anything else other than being treated.)

I’d like to see the details of how they’re going to do this. I’m sure it will be more than the proverbial single click – like documenting the patient’s consent or opt-in status, validating patient identifiers, etc. And once you have the patient identified, how useful will it be? I hope the Consortium goes “all in” with this and uses fully discrete data that can be exchanged and consumed by receiving physicians’ EHRs, not just another view vault application that’s the electronic equivalent of asking physicians to review paper documents from multiple institutions.

I applaud the groups’ ability to work out shared goals among the CEOs before it became too public. Kaiser’s CEO George Halvorson is quoted as saying, “The CEOs had to make sure the CIOs didn’t think this was crazy or impossible.” Probably a good idea, as this may have been a non-starter if too many people were at the table before the basics were agreed upon or if the CIOs opposed it.

But now that the basic agreement is done, what about the CMIOs and the actually physicians and caregivers who will have to use the system on a daily basis? I hope their input will be considered starting immediately, if this has not already happened.

How real-time will it really be? How are they going to handle corrections and errors? What about monitoring and maintenance of potential duplicate patients? Sensitive information, such as drug use, HIV status, sexual history, and the like? Patients who change their opt-in/opt-out status to avoid sharing certain information?

The devil will definitely be in the details. The answers to these questions, coupled with ease of use, will determine the success of this initiative (assuming the technical piece can be carried out in a timely and fiscally responsible way).

The New York Times pointed out that the groups also have insurance products. Collaboration could be seen as an attempt to compete with the lines of UnitedHealth, Aetna, and Wellpoint. Halvorson is quoted as saying, “This is totally focused on care.”

I really want this to work and be successful in a big way. This could pave the way for many other collaborative efforts that could be game-changers for the physicians in the trenches. The groups intend to exchange some data by the end of this year, so it should be fun to watch.

If any of the CMIOs from the Consortium organizations are HIStalk readers, I’d love to chat with you about the gory/geeky details of the project (preferably over a glass of wine and some chorizo fondue, but I’ll settle for Skype). Drop me a note if you’re interested in chatting.

E-mail Dr. Jayne.

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Currently there are "4 comments" on this Article:

  1. This project is interesting and all, but as I see it, it is mainly just a large-scale health information exchange demonstration project whose clinical utility will be minimal. Unless a patient from central Pennsylvania (home of Geisinger) blows out his ACL while skiing in Utah, I just don’t see these parties having too much to benefit from one another’s clinical information.

  2. For the life of me…I don’t understand how this consortium is going to make a big difference. Theoretically if I am driving from Pa to Ca by way of Mn and have an accident it could help. But let’s get real how many people do that, and how often?

    To me this is just another example of people running hog wild after government money or grants. It also shows how unfocused the whole HIE movement has become. Just because we have the technology to do it, doesn’t mean we should. I think each of these big PPOs should focus on their locale where they could make a real impact and forget the media hoopla.

  3. Your point on the consent nightmare that is now the #1 barrier according to the eHI HIE annual survey (surpassing sustainability which is incredible given how high a barrier that is). The group should publish the volume of patients in 2010 that went between these systems. As many have speculated, it has to be relatively low. What they will be able to do is what incredibly few in the industry have had to do – deal with the ambiguities of CCD exchange and the intense frustration and disappointment that goes with it (ask the VA for example) – lots of optional fields, no meta data describing the context of the discrete data being sent, discrete data – if you are lucky, a lot of it is text strings or text blobs that can’t be computed and this are only slightly more helpful than a fax transmission. Highlighting THIS by the big guys will put a spotlight on a deep dark industry secret. Only when we move to CCX (made that up – more like the discreteness of CCR with PCAST meta data elements), will we have an exchange language that can move system-system and retain the clinical context and value that was intended and needed by physicians on both sides.

    The first comment on the iHealthBeat posting was an interesting twist – a PHR should be the component in the middle and not direct EHR-EHR. That would certainly help a great deal with the consent piece, as well provide more robust non-EHR data that is sourced from the patient (remote device monitoring data, observations of daily living (pain, allergies,etc.) and more robust preference documentation.

  4. A lot of the questions posed can be simplified if patient consent for obtaining the remote information is all or nothing, and consent is obtained at the time of care.

    Patient matching can be simplified by using the patient discovery mechanism used by NWHIN Exchange. Similarly the standards for real time request/response for patient summary information are part of the NWHIN set of specifications. I would be surprised if these are not the basic tools used to build the connectivity of the consortium.

    Reference: http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__nhin_exchange/1407

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