Everyone seems to love talking about RHIO, HIE and all of the other various initiatives happening around sharing patient health information amongst doctors. This weekend, I want to open it up to you the readers to get an idea of what type of participation you’ve had in an RHIO, HIE or other clinical data exchange.

Are you participating in one now? Do you like it? Do you hate it? In fact, what do you like and what do you hate? Do you use an EMR to interface with the exchange? What’s the interface like? How much work is it to manage the interface?

I’d also be interested in hearing about people who are working through the process now. Where are you at in the process? What’s holding you up from making this happen?

Let’s help educate each other on what’s happening with something that I think we can all universally agree is important and INCREDIBLY challenging.

One of my readers pointed out that NaviNet was offering their Health Information Exchange (HIE) solution to state governments for free. Here’s a short part of the press release:

NaviNet (formerly NaviMedix), America’s largest real-time healthcare communications network, today announced the NaviNet Health Information Exchange (HIE), a solution that combines the NaviNet Provider Network of more than 770,000 providers nationwide, and NaviNet technology and services. The NaviNet HIE is now available to all state governments and U.S. territories at no cost, enabling more efficient implementation and expansion of local health data exchange. Adoption of NaviNet HIE minimizes technology investment requirements, providing states and territories a rapid and cost-effective way to offer their own branded health information exchange to electronically connect physicians, hospitals, insurers and existing HIEs in their regions. NaviNet is already used by two out of every three U.S. healthcare providers, and leading national, commercial and Blues health plans, resulting in significant costs savings to the industry.

I always find it interesting when someone starts offering something for free. I always have to ask myself the question of why they would offer it for free. I don’t know NaviNet that well, but it seems like this free offering is 2 fold. First, it seems like they probably want to sell the HIE to people other than government. Second, I think that they probably want participants in the HIE to also use NaviNet’s billing services.

What’s really interesting to me also is that it seems like NaviNet is basically a billing company (although, I don’t know them that well). I find this really interesting since I’ve often seen the argument that we’ve been exchanging billing information electronically in healthcare for a while. Since this is the case, many people have wondered why we couldn’t also exchange other healthcare information. Is this offering from NaviNet, the realization of this principle?

Free EMR has been going well for a while. We’ll see how Free HIE goes.

Today, I came across the best description I’ve seen of the difficulty of storing healthcare information and also making that information shareable with another EMR in a way that is meaningful.

Longitudinal patient information is arguably one of the most temporally and spatially complex information sets known. Certainly GIS and others are complex as well but the science of medicine and therefore healthcare is constantly changing creating a moving context. To understand how to treat a patient the healthcare provider needs to be able to understand what has worked as well as what hasn’t worked in the context of what was known about the patient and the treatments available at any point in time. This creates an environment of very complex data relationships. If any one of those relationships are broken then the semantic context of the data is lost and now there is a loss of information. Data items need to be bundled and stored as a complete unit of understanding for them to constitute information. Once broken apart into separate data items they are much like Humpty Dumpty.

Certainly the above description describes the challenge of storing and sharing both the healthcare information and the context of that healthcare information. I still can’t help but think that we need to simplify our goals for EMR data sharing into small achievable goals.

The above description also kind of reminds me of my previous post about the “Body of Medical Knowledge Too Complex for the Human Mind.” The description above reinforces this challenge as well.

I think that anyone that is in this industry had to be struck by the story of ePatientDave pulling his medical history into Google Health (see my previous ePatientDave post). It’s not that we didn’t already know that it was a problem. I think that most in the medical industry know the problems associated with our data right now. However, I feel like we’re all (including myself) in a little bit of denial about this fact. The story of ePatientDave just painted a picture of how bad the data really is going to be.

The takeaway I have from ePatientDave’s experience is that we’re still a long way from having interoperable patient records. In fact, it makes my previous post about ICD-10 and EHR interoperability even more significant. Not to mention the need to simplify Health Information Exchanges.

Honestly, if we don’t simplify I’m not sure we’re going to get any of this healthcare data exchanged in my lifetime.

A lot of talk has been done lately on the importance of interoperability of EHR software. Many people point to health information exchanges when talking about this EHR interoperability. I must admit that almost all of the interoperability and health information exchange discussions I’ve seen recently leave me lost. Maybe I’m just not that smart, but I also think it’s possible that people are trying to bite off more than they can chew.

I’d like to see a simplified method for exchanging health information. Let’s break it down into bite size increments where we can actually have achievable goals and solvable problems. For example, let’s start with something like prescriptions, allergies or labs. Let’s get those right and then add on top of those functioning standards.

I previously posted the comparison of the Transcontinental Railroad to EHR interoperability. The reason it was so successful with the railroad was because they only had to standardize the gauge of the railroad. We should apply that same type of simplicity to exchanging patient information and we’ll see better results.