In January of 2009, Booz Allen Hamilton issued a study outlining the need for improved Health Information Liquidity to drive healthcare reform and a genuinely patient-centered health care system. Well, with data finally moving from frozen sources to a liquid form it reminds me a bit of the melting polar ice caps and the immediate impact on the surrounding environment – i.e., flooding. In healthcare, there is a real possibility of liquefying a large amount of this data, with the intent of leveraging the data for the greater good of patients, but overwhelming the system and creating information overload for clinical care providers.
How could liquefying silo’d data create a negative effect for care givers? Well, the current standards work at the national-level has yielded a universal document to represent a summary of a patient’s care — the Continuity of Care Document (CCD). Unintentionally this format could end up being the vehicle that renders your current data exchange efforts, regardless of how noble, a big flaming disaster. The CCD is designed to contain the “minimum critical or pertinent medical information relevant to a patient’s care”, but without proper controls and filters, it can easily become the proverbial drink from the fire hose.
To avoid this scenario, it’s important to review all transition of care use cases and determine the minimum required data set for each care setting involved in the exchange. This analysis will end up serving as the implementation framework for which filters can be applied while exchanging CCD documents. For example, one of the common uses of the CCD is to provide access to an ambulatory provider’s EMR. Querying an EMR will return a patient-focused summary-of-care record delivered by that office. However, when you consider an HIE looking to present an aggregated summary of a patient across an entire community (spanning multiple data sources) you quickly realize the sheer volume of data can be overwhelming. Not to mention the overhead of compiling, transmitting and displaying that data.
As one Primary Care Physician told me during the implementation of a Health Information Exchange, ‘Sending me all of the lab work while my patient was an inpatient has no value to me and is clogging up my EMR … it’s annoying and just adds work and time for my support staff.” Freeing data from silos within hospitals, physician offices, clinics and other healthcare settings so that it can be used to make informed diagnostic and treatment decisions is the goal. Think through your implementation use cases and protect your users from being overwhelmed with the amount of information sent to them on day one.
