Home Forums Discussions General Discussion Electronically exchange clinical information

Does anyone, especially V6 beta testers, how AC intends to meet the meaningful use requirement to electronically exchange clinical info among providers?

I met with Washington State HIE yesterday, and they are implementing an adaptor that runs on the server. The requirement is for the EHR to put exported files in some agreed-to directory and pick up import files there. If files are XML, they can hopefully be parsed and matched automatically. Does AC6 already have this capability, or do we have to pay for an additional interface?

Also, I see in AC5.6 the link to state immunization registries. Is that another interface to buy?

Our state HIE has been working with AC on this, but also don't have many details. When I spoke with them, they were also unclear just WHAT would be able to be exchanged. If they mean something like the continuity of care record, that is so pitiful as to not be worthwhile bothering with. Does anyone know what sort of clinical information is going to be exchanged?

It would appear that this most basic question cannot yet be answered. Here is a link to HIStalk which is quoted below. The quote is fairly long, but even so, I would suggest you read the entire blog as it is very informative. It is, however, just opinion:

"Looking at the Core Requirements, the most difficult requirements seem to be (in order of difficulty):

Capability to exchange key clinical information. The biggest difficulty with this objective seems to be figuring out what the heck it means. What are ?different legal entities?? What are ?distinct certified EHR technologies?? What is ?key clinical information?? What does it mean to ?electronically exchange? key clinical information?

There are some answers available at CMS, but health care delivery is too complex, and the FAQs a tad too vague, to be really useful in many if not most circumstances.

One large source of confusion with this requirement is whether it requires some kind of connection to a Health Information Exchange. The answer is a resounding NO. Indeed, meeting the requirement doesn?t seem to require an electronic connection to another practice at all. All it requires is that a valid clinical summary CCD/c32 be generated from one certified system, and that an attempt be made to upload it into another distinct certified system.

Thus it would be perfectly acceptable to create the file using your certified EHR system, encrypt it (using a cheap and easily available commercial utility like WinZip, for example), pass the file to another practice on a CD or a thumb drive or even using commercial e-mail (like Gmail or Yahoo), and ask them to try to upload it into their system.

Doesn?t have to be through an organized HIE activity. Doesn?t have to be structured data. Doesn?t have to be transported electronically, since ONC somehow decided not to create any standards for that. Doesn?t even have to be successfully uploaded by the receiving practice! It?s like testing my high school son?s ability to show up for the SAT exam on time and with a number 2 pencil, rather than his ability to actually answer the questions on the test. (He?d be thrilled!)

If you are part of an organized HIE activity (like the New England Health Exchange Network, for example), you can transport your test file electronically. And some EHR vendors are helping their customers meet this requirement by matching up different customers with each other and facilitating transport through their own proprietary exchange infrastructure.

For example, eClinicalWorks, Medent, and Epic provide this service to their customers. But if you don?t happen to have such options, you can go just do it the old-fashioned way described above, and maybe even make it a little fun. ?Hey Dr. Jayne, bring your flash drive on Wednesday morning and we?ll take care of MU before our tee time.? "

What about Dropbox?

Bert, I can see a use for Dropbox or other services like it.

It seems that the requirements have put the cart before the horse. The most basic questions need to be addressed first. If I have no EMR, just paper charts, I can scan them, create a pdf and email it, put it on a drive or a CD, or use Dropbox to transmit it. Can I get my $44k with that?

I assume that doesn't meet MU requirements...but other than the lack of an EMR, why wouldn't it? We need standards; right now the "M" in MU is for "meaningless". Until the basics are defined, I suppose we can all attest that we can meet the requirements!

GI Jon, you are right, of course, in that any exchange is OK for MU. However, I am still interested in AC6's capabilities. I see buttons in AC5.6, for example CCR Import in Administrative Options, but nothing happens when I click it. if I pay the money for HIE ($600 per year for our size), I could actually use the data. If enough practices and systems participate, I can get the four basic data sets (lab, eRx, CCD, eligibility) electronically, and hopefully imported automatically, into AC.

Interest in this HIE from CMIOs of other clinical systems range from enthusiastic to lukewarm, at least no one said no. Of course, the majority of them are on EPIC, and can use EPIC Anywhere and NHIN Direct.

Jack,
I did not mean to be dismissive of your interest in what AC6 can do in this area. In fact, I would imagine that virtually everyone who upgrades to that version will want to know the answer to your question.
Two connected issues are what the program can do that will be useful, and what the program can do to meet the MU $ requirements. Sadly, the latter will likely be the focus, and unfortunately we will be trying to jump through hoops that have not even been constructed yet.
I applaud your interest in actually using the new capability to improve patient care.
I am using V5.028 and it does allow me to create a CCR to export, but as you said, the CCR import button does not function.

As far as I can tell, the CCR provides a bunch of demographics on the patient, a med list, and diagnosis list. Much less than we used to carry around on a 3X5 card as a resident. I fail to see how this is supposed to be useful.

The CCR was standard developed by the American Society for Testing and Materials (ASTM) to facilitate transfer of a "snapshot" of a patient encounter. I have nothing against the engineers who wrote the standard, but as David has said, it contains little useful information, and no one uses it -- FAIL!

You can use v6 to encrypt files. It's a little cumbersome, and I am not sure why it's not .pdf and .enc, but instead some HL7 thing. I mean I know what HL7 is, but it doesn't seem like it belongs in the process. I think other encryption techniques are easier as Jon mentioned and having the ability to right click and encrypt is much faster. But, I suppose it makes the program that much more "meaningful."

Sorry that it didn't turn out as well as I would have hoped. Needed v6 and I had to install that on my VM, so I guess it didn't look as good.

http://www.box.net/shared/static/c2gipolsoh.zip

Bert,

I recently started to send info electronically by printing it to adobe and then encrypting it and attaching it to an email. Is this secure enough for HIPAA?

Lois

Yes, I would think so. But, then you run into the user on the other end who doesn't know the Start button from the Task Manager. But, I guess it doesn't matter according to MU if you initiate the HIPAA transaction.

Bump. I called Angel support and had the email address for someone at AC who supposedly did the interfaces. Asked the same question as above (how to make AC connect to Washington HIE) but no answer so far. Does anyone know how to get AC to interface to something they are not yet connected to? Who to contact? Or does someone have the experience of asking for a new interface and gotten it?

As I understand it, you just contact Jon and he will make you a custom interface. I understand it to be like $5, 000 or so. On another note, why did you type bump when you were going to write a post anyway?

Absolutely. Just send me your checks for $5000, and I will send you an interface. It will be a beta version that may not be functional for a couple of years. Actually, I would prefer cash, in small bills.
Is that what you meant, Bert?

make sure the bills are "unmarked" and non-sequential.

Bert, I typed bumped to see if I could get any other response, and then forgot that I needed to add the note about having contacted AC. Forgot to delete bump. Sorry.

I don't really want him to write a custom interface. OK, I do, just don't want to pay $5000 for it, at least not by myself. I just want to know how AC will handle the 50 state HIEs. Even AC charging the standard $500 is probably not going to entice me to join the HIE (which is another $600 per years at this early adopter point).

In general, if the HIE wants you, they should pay the fee, no different than a lab. Wouldn't be in a hurry to adopt unless they absorb the fee.

I might be able to come up with an alpha version for about $2500 though (Of course small nonsequential untracable bill rule still applies)

Wendell, what ever happened to your motto "I like free"?
I think you need to move this to the vendor board. (That is if you want to compete with me).

Apparently for "meaningful use" at least at this stage, electronically exchanging data means that you put a CCR on a thumb drive and go to someone elses office and see if you can upload and view it in another physicians system. Or so I've been told.

It was only half so you could get the other $2500, think of it as fee splitting, (wait, isn't that illegal ?)

I like free, just not when I'm selling it

ok, aside from the whole big bucks business...i can fax office notes from my desktop to any other practice...wouldn't that be considered exchanging clinical information electronically? i vote yes!

HIE are the clearinghouse mechanism for connecting EHRs. I'm in the process of trying to get AC to connect to my HIE so hospital dictations, labs, and specialist notes may be imported as true electronic text files. We should all be aiming to eliminate faxed/scanned documents.

I suspect in the near future, meaningful use will likely require HIE integration. Opinions?

I doubt if an HIE will pay for writing an interface, it's likely more on us and AC. That said if it's going to be part of meaningful use and help us eliminate scanned/faxed reports, then it should be part of ACs priority. We simply need to make it known that it's important to us.

Larry
Internist
Ohio

It is NOT important to me. Apparently it is important to the feds and the AMA. I find that faxed and scanned data are fine and entered in a very organized fashion in my ehr. I can access them quickly and read them without difficulty.

If HIE does not write the interface, I sure as heck will not be connected. This is not a expense that I am willing to bear. It does not benefit me or my patients. I recently attended a seminar where I was lead to believe that this will happen for me through grant money. That is the only way it will happen for me. Just saying...