I had a post by Dirk Stanley, MD recently pointed out to me where Dirk discusses the challenge of deciding which information an HIE should pass. Dirk is the CMIO at a hospital and also a genuinely nice guy. He frames the answer to the HIE data passing question really well:
And after a rousing discussion, the answer I heard was this :Everyone has a different opinion.
I guess it’s entirely understandable… ICU docs, PCPs, surgeons, specialists, hospitalists, and everyone else has a common goal – making the patient healthier – but they have different training and thus they all have different needs. This is why when I hear docs say “I just need the important information!“, I smile because ultimately, all of the information in a chart is important - It just depends on your context and clinical needs.
So I’m left with the ultimate Informatics challenge - How can we get the right information to the right person in the right place in the right time in the right way? Especially when everyone has a different opinion on what the right information is?
He then offers this zinger which describes the real core of the problem: “Looking at the current buffet table of documentation, it’s no wonder that every doctor has a differrent opinion of what they need. There aren’t really any hard standards for clinical documentation.”
Dirk then goes on to describe his solution to the problem which essentially revolves around the idea of a new type of note that can be transferred. You can read all the details in his post.
Reading through Dirk’s thoughts on the subject I’m reminded of the conversations that surrounded the creation of CCR back in the day. They seem to have taken a very similar approach to what Dirk describes. I wonder what Dirk thinks of the CCR (now basically merged with CCD) standards that are already out there. Do they not cover what he has in mind? Are their gaps in the CCD standard that don’t cover his “new note?” Could we just improve the CCD standard to cover those gaps? I’ll ping Dirk and hopefully he’ll join the conversation.
The real challenge when looking at what data should an HIE pass is that computers aren’t very good at understanding context. I’d be interested to hear people’s thoughts about this and how we’ll solve this problem going forward. My gut feeling is that we need to start with something that will solve a lot of problems for a lot of people. We don’t need something that will solve all things for everyone from day one. We can incrementally improve the exchange of data as we go forward.