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We Need To Unboggle Health Information Queries

by Wes Rishel  |  February 12, 2013  |  6 Comments

Health Information Exchange (the verb) requires a massively complicated boggle of policy, trust and technology issues.

In 2010 ONC chose to carve “push transactions” out of the boggle. It asked the HIT Policy Committee Privacy & Security Tiger Team to provide specific policy recommendations around pushing, which it referred to as “directed exchange.” The Policy Committee approved and forwarded the recommendations to ONC in September 2010. Three and a half years later, 97 percent of about 27.5 million transactions per month that flow through HIEs are pushed. Only about 3 percent are query-response transactions.1,2

We need more progress on queries. The same approach, carving a subset out of the boggle can work again. Epic’s Care Everywhere constitutes an existence proof that there is a workable set of queries that healthcare delivery organizations will support with automated response given the right framework of trust and operating agreements.

The open questions are whether such a capability can be expanded to multi-vendor approaches and whether it needs be operated exclusively by EHR vendors. What we don’t need is to regulate an approach based on a single vendor. We don’t even need to exactly follow the Epic model.

I am happy to report that the Tiger Team is now working on policy statements that are comparable to the 2010 effort on directed exchange. The new work targets a specific set of circumstances where health record holders may safely respond to automated queries. The policy may also support electronic transmission of the request and response even when the workflow includes a manual review of the request. As with directed query, the policy should support a number of technological solutions.

This is a very important start. Many questions remain to be answered about the appropriate standards, the degree to the industry should rely on standards vs. competitive approaches, the level of trust that must be supported and how ONC could accelerate such an effort through meaningful use Stage 3.


1These percentages were computed from data reported by Mickey Tripathi on 29 January 2013 during Tiger Team testimony on health information exchange.

2All of the pushes described in are enabled under the “directed exchange” policy. Not all of them are transmitted using the Direct protocols. Likewise, not all data sent with the Direct protocols is routed through an HIE that reports traffic to ONC. Because of the decentralized nature of Direct it is hard to assemble traffic estimates.

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Category: healthcare-providers  interoperability  vertical-industries  

Tags: ehr  health-information-exchange  health-internet  health-it  healthcare-interoperability  healthcare-providers  meaningful-use  

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

Thoughts on We Need To Unboggle Health Information Queries

  1. Mike Davis says:

    Isn’t this what “Connect” and the Aurion Project are trying to do?

  2. Would be very neighborly and patriotic if Epic were simply to open source their query sets and put them into public domain.

    Not holding my breath.

  3. Wes Rishel says:

    Vince, what do you mean by putting query sets in public domain? What would be accomplished if they did it?

  4. Wes, You write:

    “Epic’s Care Everywhere constitutes an existence proof that there is a workable set of queries that healthcare delivery organizations will support.”

    First of all, thot it was obvious that my comment was tongue in cheek. I believe Epic would be the last company to share anything that they consider is “theirs”..

    That said, the suggestion could be taken seriously as well. I presume that what you describe as a “workable set of queries…” is documented in (proprietary) software code and/or algorithms. That’s what I’m suggesting could be shared — no need to reinvent the wheel.

    Why couldn’t Epic’s code and/or algorithms become an open source, de facto industry standard? (Still not holding my breath.)

    If I’m missing something here, share an example of what might be contained in their “workable set of queries”.

  5. ps Wes, you also write “We don’t even need to exactly follow the Epic model.”

    My suggestion would be, if it works, why NOT exactly follow the Epic model? Why recreate something new? I presume they would consider their “model” to be intellectual property, and I’m suggesting they could contribute their “model” to the public domain.

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