Health Information Exchange Hospital Participation: Fill & Download for Free

There are a few ways in which your doctors might be able to access your electronic medical records held by other hospitals or clinicians. The two most likely scenarios are that:The other hospital medical practice uses the same software as the hospital outpatient clinic you're visiting now. For example, if both use software from EMR vendor Epic systems, they can access your external records using a tool called Care Everywhere.Your current and previous provider participate in a health information exchange network. In that case the data might be a bit more truncated, as it’s hard to share data in a form that everyone can use with their particular EMR.I'm curious why you asked this question. Do you see such data sharing as a benefit or a concern?

DHHS awarded more than half a billion dollars in 2010 to state-designated-entities (politically-connected) to implement state-wide health information exchanges in all 50 states plus. In response, health care software vendors and health care consultancy firms spun up their pitch machines, garnering millions in revenues in the process. I've heard all manner of sales pitches, including those suggesting that systems based on MUMPS, a programming language developed in the 1960s, are best-positioned to solve health care interoperability problems.Assuming that your goal is to build a robust, successful HIE (Health Information Exchange) that easily and securely forwards EMR information between physicians, such that each physician in the HIE network has anytime/anywhere access to a complete and accurate cloud-based virtual medical record of the patient, then you'll need the following core technologies:A clinical data warehouse.This is a very-well-designed database built upon a non-trivial logical data model that captures and stores all patient data transmitted by every participating EMR/LIS/ADT system. Edgar Codd's relational model is the clear choice for modeling patient data, which implies that the "language" for the data warehouse is SQL -- minimally ANSI SQL-92, the lowest common denominator for DB2, Microsoft SQL Server, MySQL, Oracle, PostgreSQL, etc.A Master Patient Index (MPI). This allows you to merge/de-duplicate patient records. There is no "language" here, though there are a range of apps, from open-source to proprietary vendor products such as IBM's Initiate, that carry out the MPI role.An HL7 data interchange engine. Health Level 7 is the defacto data interchange standard implemented by the major EMR and LIS vendors. http://www.hl7.org. We can safely assume that the physician's EMR will exchange data with the HIE's clinical data warehouse via an HL7 data stream. In my experience, the EMR/LIS/ADT systems currently deployed by hospitals generally support the HL7 version 2.x standard -- pipe delimiters, real-time handshake requirements, etc. It works, sort of. But it's not very extensible, and the real-time connection has to be rebooted on occasion. HL7 version 3 replaces the HL7v2 direct-connect protocol with a store and forward data interchange model, and also replaces Hl7v2's constrained pipe-delimited architecture with an extensible XML model for encoding and exchanging data. Mirth has a very robust open-source offering that can interface HL7 streams to SQL-based clinical data warehouses. There are also commercial HL7 products such as Cloverleaf.A terminology mapping system. Something that "knows" that dyspnea, shortness of breath and breathlessness are synonymous, and that "knows" what a problem list entry of "New onset CP, 3 wks S/P STEMI" means, and how to map the problem list entry to the appropriate SNOMED CT and ICD-10-CM codes. The NLM's UMLS would be the obvious choice here, though the DoD, VA, and 3M just announced public access to 3M's health care terminology mapping system.That's just the technology, which could be the easy part. Getting solo practitioner physicians and multi-hospital health care enterprises to collaborate on health data interchange is where the real skill comes in.

Obamacare has been an unmitigated failure.Even before Trump, the exchanges were collapsing, premiums were rising out of control year over year, and insurers were pulling out.There were a number of entire states where Obamacare enrollees had zero private options because insurers were not participating.How exactly is that success?Fundamentally, Obamacare failed because it was solving the wrong problem. It was trying to solve the problem of excessive cost, with the assumption that cost is primarily driven by people who lack access to care avoiding care. The thing is, when it comes to chronic disease (85% of total cost), there isn’t much of a difference between those who have insurance and those who don’t in terms of chronic disease risk:If there isn’t any statistical difference between insured and uninsured when it comes to disease risk, focusing on reducing uninsurance rate was more of a political move than it was an effective approach to resolving the real problem - why is everybody getting chronic disease at more of less the same rate, regardless of access?Another issue is that Obamacare was passed on the heels of the HITECH Act (Health Information Technology for Economic and Clinical Health Act - Wikipedia) - health systems were still in the process of digitizing medical records and building entirely new processes around that. And still are. To give you some context, the HITECH act mandated that all providers transition over a period of time from the paper health records to completely digital records. If you’ve ever been part of a major technology paradigm change in a corporate setting (particularly one as change-averse as healthcare) you know how much of a headache implementing electronic medical records has been and still is. If you’ve worked in a hospital in the last 8 or so years, you have a first hand knowledge of that headache.On top of that, 1/3 of all hospitals are cash flow negative. In general, hospital margins are tiny - in an industry where even a 100 bed hospital can generate over $500M in revenue/year. Crazy, right?So, we have a scenario where hospitals with tiny or negative margins are required to completely overhaul how they manage information within a 7–8 year period. In an industry that is allergic to actual innovation and beyond pharma and insurers, is terrible at running themselves as a business. And we expect them to overhaul the exact care models that allow millions of Americans to fall thru the cracks with preventable chronic disease and overprescription of opioids.Not a reasonable expectation. At all.As much as I like Obama’s public persona, I think he suffered from the same egomania that drives anyone to pursue becoming POTUS. He was likely more concerned about his legacy than he was about putting in place a model that would drive the kind of business model and health practice innovation that our system actually needs. The excessive cost of our healthcare system is a direct result of how badly our health system helps people manage health before they get sick, as well as a bias within how medicine is practiced towards specialist care (specialists only make their money when people come to them with big health problems). We are great at staving off death and things like cancer or trauma surgery survival rates. We are the worst in the developed world when it comes to preventive health. Which is why our life expectancy is only 6 months higher than that of Cuba, a nation that has gone all-in on a national preventive care model.