Wes Rishel

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Wes Rishel
VP Distinguished Analyst
12 years at Gartner
45 years IT industry

Wes Rishel is a vice president and distinguished analyst in Gartner's healthcare provider research practice. He covers electronic medical records, interoperability, health information exchanges and the underlying technologies of healthcare IT, including application integration and standards. Read Full Bio

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Simple Interop: Use Cases

by Wes Rishel  |  January 4, 2010  |  4 Comments

This post zeroes in on exactly why the simple interop approach is important. It does so by listing a number of use cases. They illustrate the issues of getting to interoperability while an industry is in transition – and are industries ever not in transition?

We are mindful of the specific kinds of interoperability required to obtain incentive funds under the ARRA. The regulation is available at this time here. Our approach is directly applicable to all of them except ePrescribing. However our approach is also mindful of one of the main challenges of going able from being able to interoperate to actual interoperation. To make the most use out of interoperability provided to EHR vendors it will be necessary to interoperate with many healthcare organizations that don’t have EHRs. (See Rant on Heath Information Technology Asynchrony for more specifics.)

Use Cases
We expect the simple interop approach to handle both person-to-person communication and the automated transmission of information from one information system to another. Some examples of these two modes of communication are listed below.

  1. Doctor A sends a secure email to Doctor B, an attending physician at the local ED, about a complex patient who is rushing over. Docs A and B both have EHRs but there is not yet HIE in their town to connect them or they are signed up with different HIEs.
  2. Doc A sends the same secure email to Doc B, but Doc B does not have an EHR.
  3. A physician sends an email to a patient (at his health Internet address) about the patient’s case
  4. At the close of each encounter, an EHR automatically sends a summary to the PHR designated by the patient.
  5. Upon discharge a patient asks that the discharge summary to be sent to her home physician in another state; she has the physician’s health email address in her address book.
  6. After and ED visit for breathing difficulties a mom asks that a summary be sent to her son’s pediatrician. She is able to provide the name of the physician and the town where the pediatrician practices, but is not sure of the name of the practice. The ED staff is able to find an unambiguous entry in a health Internet 411 service but it is not clear whether the pediatrician has an EHR or not.
  7. Upon reading a preop treadmill ultrasound a cardiologist needs to send the report to the surgeon and the primary care provider, and to the patient. The patient and his PCP live in a rural county across a state line a different medical services region than the cardiologist and surgeon.
  8. A patient is brought to the ED with severe cardiovascular symptoms. The patient says he was treated six weeks ago at another hospital. The other hospitals is not connected to an HIE. The patient gives consent to get the records from the other hospital, so the local ED staff calls the hospital. Over the phone the ED gives the other hospital information to identify its healthcare email address and the records are sent from the other hospital’s EHR to the ED which adds the contents to its EHR. Some of the contents were sent as structured data including a patient summary and others of the contents were textual reports with the minimum structure necessary to identify the report with the patient and give the type of test reported.

These cases are similar in the following respects.

  • Communication occurs across healthcare organizations
  • It is likely that the two organizations will be at different levels of adoption of healthcare information technology.
  • It is desirable to send structured data when possible
  • It is desirable to send human-readable information when it is not possible
  • It is tedious (in fact impossible) for one HCO to keep track of the status of another with respect to its ability to use structured data formats.

We submit that these are the real challenges of actually achieving interoperability about a lot of patients for a lot of healthcare organizations over the next four years.

Our next post,   Simple Interop: The Payload describes how to exchange structured using the simple interop approach.

This blog was amended on 7 January 2010 per user comments.

4 Comments »

Category: Healthcare Providers Interoperability Vertical Industries     Tags: , , , , , , , , , , ,

4 responses so far ↓

  • 1 Simple Interop: The Payload   January 4, 2010 at 9:44 pm

    [...] ← Simple Interop: Use Cases [...]

  • 2 Thom Kuhn   January 5, 2010 at 9:04 am

    Please get rid of use case 9. I find it unbelievable that people think that this sort of scenario is a reasonable idea. Why would you want busy rural docs or their staffs to waste time they don’t have browsing through their patients’ PHRs online? Let alone expecting them to keep track of the identities, locations, login credentials, differences in interfaces and terminologies used by all the different PHR providers that patients will use, drop, and be assigned over time? Please do not suggest that there are situations where doctors should be logging in to external systems and browsing for possibly relevant data. I am going to stop using email. Instead, I am going to post all of my emails to my Facebook page. I will expect all of my usual and even occasional correspondents to log in and check my wall periodically to see if I left them a message. Everybody else should do the same.

    Provide useful information to doctors. Do not require or expect them to go looking for it.

  • 3 Wes Rishel   January 7, 2010 at 5:41 am

    Thanks, Thom, as always the value of you input is only enhanced by its candor :-)

    I did delete it, although it is modeled on a successful project in Mendocino and other California counties for clinics that serve migrant workers and their families. My reason for deleting it is to avoid controversy unrelated to the main thrust of the simple interop approach. Fundamentally, I think that project is more of a shared, simple EHR for physicians in a network of clinics that primarily serve this population. If a doctor is seeing a child with substantial asthma he can be pretty sure that the child has been seen in another clinic since the last time the lettuce was picked locally in his location. The choice is not so complicated as you depict … look up the patient on the community system or go with the out of date paper record. That project issued photo-ids to patients so lookup is not as complex as one might have thought.

  • 4 Simple Interop: Issues Associated with Automatic Processing   January 22, 2010 at 2:38 pm

    [...] Simple Interop: Use Cases we have made a somewhat unorthodox proposition, to support mixed communication between people and [...]