Build a roadmap for meaningful use

Whether your organization has health information technologies (HIT) in place today or preparations for meaningful use are just beginning, the time is now to understand your environment, locate where patient information exists today and prioritize your needs. Care providers are incented to adopt meaningful use by 2015; after which date Medicare reimbursements will be reduced.

Enterprise data management is complex and even further complicated by the data quality and political governance challenges that arise when organizations attempt to share or exchange information.

To understand your ability to create a patient centric record that is complete, timely and accurate, ask the following questions:

2. Can updates to this information be shared with outside facilities or between inpatient and outpatient facilities?

3. Are there gaps in the information due to its location in specialty systems or practices outside your organization's four walls?

4. How much time does your staff spend seeking information to facilitate care coordination?

5. Can you achieve a single view of patient data across your organization to report quality measures?

Patient Registries

Many detailed questions remain regarding what constitutes "meaningful use." However, the goals of meaningful use of HIT seek to achieve improvements in patient safety, reduce the cost of care delivery, prevent disease, better coordinate care and improve population health while ensuring that patient privacy is protected. In order to achieve these goals, interaction and interoperability must increase across multiple points in the healthcare ecosystem. This requires bi-directional information exchange and improved communications about patient status and outcomes among providers, patients, and care facilities.

Health information technologies such as electronic medical records, personal health records (PHRs), e-prescribing, practice management, health information systems (HIS), and clinical portals each contribute to improvements in information access at many points of care. However, these technologies alone do not deliver a shared, consistent longitudinal patient medical record necessary to meet the goals of meaningful use. Patient records must be located across system silos and properly linked to make available a record that is suitable for sharing across all points of care, both internal and external to the healthcare organization.

A patient registry is a necessary component of the information exchange infrastructure that links different representations of a patient between systems, facilitates access to relevant information, and lets interoperability be realized. Having a patient registry at the foundation of your HIT infrastructure allows you to leverage the systems you have in place today and create a meaningful EHR that links patient records across registration, clinical and lab systems.

Associating patient medical records helps caregivers access all relevant information about a patient regardless of the way the data is maintained and managed from one system to another. The patient registry facilitates adoption of the EHR by enabling secure, consistent and coordinated communication between providers to create a trusted patient-centric view. These capabilities enable providers to confidently access information and make more timely and effective decisions. The end result is an improved workflow that allows healthcare organizations to deliver patient-centric, coordinated care and reduce the number of adverse events while also reducing overall cost of care.

Patient Registry Requirements

Evaluate a patient registry for your organization based on these key requirements to enable health information exchange and trusted use of patient information across systems:

1. Integration with New and Existing Systems: A patient registry should seamlessly integrate with the existing IT infrastructure including specialty systems and new technology as it is enabled. It must be hardware and software agnostic to support interoperability efforts without disrupting current systems or replacing legacy applications.

2. Data Governance and Control: Healthcare organizations must manage what data is shared and with whom based on patient consent. When patient data is requested by another organization, the patient's consent preference, which may be stored in the patient registry or in an external enterprise security framework, must be honored. A patient registry can help healthcare organizations overcome common privacy challenges encountered with distributed data ownership, limiting data access to only authorized users.

3. Efficient Data Management: An effective solution must deliver both automatic data issue resolution capabilities as well as tools to alert data stewards to where manual resolution is required. Without these tools, significant human resources will be required to accurately collect data across heterogeneous systems, and cost reductions will not be achieved.

4. Scalable across Multiple Sources: The patient registry must be capable of supporting additional systems over time without a negative impact on performance or response time. It must scale to support large numbers of transactions per second across a diverse ecosystem of applications to meet the demands of real-time access to patient information. It must also search across not only current but also historical demographic information to enable comprehensive matching across patient historical records.

5. Standards Compliance: Cross-boundary information exchange to enable care coordination requires compliance with standards for data sharing to ensure ongoing interoperability with systems that you cannot redesign. A patient registry must support leading healthcare standards such as HL7 and NIST and should have successfully demonstrated compliance with the Integrating the Healthcare Enterprise (IHE) profiles supporting patient matching and data sharing, including PIX/PDQ, PAM and ATNA. These profiles demonstrate rigorous testing in real-world scenarios -a true illustration of today's healthcare environment.

6. Extensible beyond Patient Data: Interoperability is a journey, not a short-term endeavor. After connecting patient records between affiliated facilities, the scope will expand to non-affiliated providers (community physicians), payers and government agencies. A connected community facilitates coordinated care through a broader understanding of the patient, their providers and the relationships between them.

7. Proven Implementations With Real World References: While interoperability and exchange of information is not a new frontier and many healthcare organizations have achieved this today, achieving interoperability can be a difficult challenge. To ensure success, it is critical to leverage the experience and best practices from healthcare organizations who have overcome common challenges.

Do not wait for the meaningful use criteria to be finalized to understand the current state of your systems and future needs. Be prepared with a vision for how to achieve a patient centric view and enable bi-directional exchange across boundaries to improve care coordination and patient safety and ultimately reduce the cost of healthcare delivery in the U.S.

Lorraine Fernandes, RHIA, is vice president and ambassador for Initiate Systems, a leader in enabling healthcare organizations to strategically leverage and share critical data assets. Lorraine is a nationally known expert on electronic health records in association with regional health information organizations (RHIO), health data exchange, and patient identification issues..