Different hook ups complicate information exchange

April 6, 2009

Efforts by the Obama Administration to make healthcare more efficient will succeed only if an efficient way of connecting different healthcare IT systems can be found, an objective that could get tougher as more institutions adopt IT. The challenge will be getting the different types of systems to talk to each other.

Efforts by the Obama Administration to make healthcare more efficient will succeed only if an efficient way of connecting different healthcare IT systems can be found, an objective that could get tougher as more institutions adopt IT. The challenge will be getting the different types of systems to talk to each other.
In a presentation at HIMSS09, Jamie Ferguson, executive director of health IT standards, strategies and policies for Kaiser Permanente, described the scope of the challenge in terms of these different “topologies”, but said there were viable ways to meet this challenge.
The simplest topology is a community system, one that links private and group practices or outpatient clinics. In these, data flow in and out of centralized data bases, drawing from a single master patient index, sometimes called patient registry, and using a single record locator service, the central index that directs queries to the right place to find records of patients. Together they compose the health information exchange (HIE).
More complex systems use so-called “edge systems” that connect to the HIE. These edge systems might be generate hospital electronic medical records (EMRs) or personal health records (PHRs).
“Now is when it gets fun,” said Ferguson, who outlined the increasingly complex flow of data in a series of slides with arrows cascading into and out of HIEs and color shadings demonstrating the crossover between HIEs and data access points used by clinicians.
In some of these topologies, the master patient indices and central record locators were sometimes inside the HIEs and sometimes outside.  Edge directly connected in some and not in others.
Increasing sophistication typically involved decentralized archives, dependent on decentralized query systems to convey information. These systems request information from edge systems, which – as their names imply – hover on the periphery of the HIE. In one of the most advanced applications of healthcare IT, the edge systems manage their own queries, Ferguson said.  In these, chaos is avoided by using standardized protocols that keep the queries on track
Ferguson described “cross community access” as the ultimate HIE model, one that connects various HIE topologies  together, managing requests for information by directly accessing a specific HIE, if the location of the data is known, or sequentially asking HIEs until the data are found – a kind of “lateral” discovery process. 
“The key point about accessing the data is standardizing the gateway protocols not they topologies (types of HIEs),” he said. “It doesn’t matter if data are centralized or decentralized data. So long as the protocols are standardized, the systems will be able to respond with the appropriate clinical data about patients.”
Ferguson presented the choice of various approaches as a reflection of the institution’s needs and IT capabilities.  The simplest, he indicated, is well within the grasp of any care provider institution with the will to go electronic.