In my recent post about hosted EHR versus client server EHR Dr. Rowley commented on the various scenarios that could occur for sharing a patient record. The comment was so worthwhile that I wanted to make it it’s own blog post and add a few comments of my own. Here’s Dr. Rowley’s comments on data sharing scenarios with various EHR:
Whether you are an enthusiast of free, hosted, web-based EMRs, or an enthusiast of local client/server installations (or a wait-and-see skeptic), the question of data sharing is one that is important to us all.
Maybe the discussion can be best moved forward by considering a real-life scenario and examining how data sharing can occur in different situations. Let’s say that I am the Family Practitioner taking care of Mr. Chest-Hurts, who just was released from the hospital after a heart attack, and you are the cardiologist who saw him there. Mr. Chest-Hurts is in my office for post-hospital follow up, wants a referral to see you as an outpatient, had numerous tests done (which I don’t have in my records when I see him), states that you changed several of his medications on discharge and is confused as to which ones to take (and did not bring them with him for his visit). I just did some lab test and found his cholesterol to be not-quite-at-target. Let us assume that the referral is a simple administrative matter that happens anyway. What is important for patient care here is for us to share our records with each other – we need to reconcile his meds lists, you need the labs I just got, I need the cath report from the hospitalization, etc. Now let’s explore how we share data, given different scenarios:
1. Neither of us have EMRs; we both use paper charts. In this case (the traditional one in medicine), we copy and fax information to each other from our charts. We take each other’s faxes and make them permanent parts of our own separate charts.
2. I have a client/server EMR and you use paper charts. I generate a fax to you from my EMR, which you place in your paper record. You fax records to me, which I scan and import into my EMR.
3. I have Practice Fusion, and you use paper charts. Several options exist here: (a) I can generate a fax to you, like scenario #2 above; or (b) you sign in to Practice Fusion (after all, it’s free, and with “Live in Five” provisioning, you will be able to have access almost immediately). You can then print out what you might need, for inclusion into your own paper chart.
4. We each have client/server EMRs (maybe the same one, or maybe different). Like with paper, we each have separate chart records, and there is no unified patient identifier. A few options exist here: (a) we each have our systems fax out the desired records to each other, and import the data as scanned documents into our separate charts; (b) we each output a Continuity of Care Record (CCR), and somehow push it to each other. There are some efforts (like Relay Health, for example) who are trying to build an infrastructure to be an intermediary for CCRs – I push out a CCR and post it to Relay Health, and you look there and import the CCR directly into your EMR. This need to build a connection between local installs is a challenge (weakness, in my view) of local client/server systems, and will take effort and money to build. There is a lot of activity here.
5. I have Practice Fusion and you have a local client/server EMR. Several options can take place: (a) we each fax our information to each other; (b) we exchange CCRs (like #4 above); (c) I give you access to Mr. Chest-Hurts’ chart (like #3 above), so that you can see the record, and copy-and-paste between the systems if desired.
6. We each have Practice Fusion. We can share the same record on the same patient, and with the right permissions, can see each other’s notes, shared lab values, meds lists, etc. No uploading or downloading of CCRs required. No faxing needed. This is the most compelling scenario.
Pardon my long-windedness here, but my belief is that the discussion of data sharing is very important, and vital to unlocking the true potential of e-tools in improving health care in this country.
I’ll be posting my comments on these scenarios in my next entry.