Magazine article Behavioral Healthcare Executive

Confidentiality Alternatives for Exchanging Electronic Medical Records Take Shape: Progress Is Accelerating, Though Large-Scale Solutions Appear Years Away

Magazine article Behavioral Healthcare Executive

Confidentiality Alternatives for Exchanging Electronic Medical Records Take Shape: Progress Is Accelerating, Though Large-Scale Solutions Appear Years Away

Article excerpt

The Office of the National Coordinator has focused the nation's Health Information Technology around the goal that "information follows the patient." That's "secure" information, available whenever and wherever a patient seeks care, explained Michael Lardiere, the National Council's VP for Health Information Technology and Strategic Development.

Models of Health Information Exchange

Having a patient's electronic health information available whenever and wherever it's needed is still a vision rather than a reality, Lardiere continued, outlining three models of health information exchange to a gathering at the California Institute for Mental Health's recent Behavioral Health Information Technology Conference: the Direct or "push" model, the Query or "pull" model, and a Consumer-mediated exchange model. In coming years, all will have a role to play.

Of the three models, the Direct model (based on the National Health Information Network or "NHIN Direct" protocol) is the only one that is readily available for use today. Providers who have a Direct account can use it to communicate, point-to-point with other providers that have a Direct account for a cost of about $15 per month. Lardiere added that providers pursuing Stage 2 Meaningful Use incentives will likely need Direct to meet the requirement to make 65% of care referrals electronically, with a minimum of 10% of care referrals made outside their "home" network

The second exchange model is the Query or "pull" model, which is built around the concept of health information organizations (HI0s). This exchange model is being piloted on a large scale by five major national health networks--Geisinger, Intermountain, Kaiser Permanente, Cleveland Clinic, and the Mayo Clinic. "The goal is, no matter where you go, your provider can search for your record, pull it down, and provide treatment for you," Lardiere explained.

The third model of exchange--Consumer-mediated--envisions a consumer who actively participates in using and sharing personal health information. Lardiere said that these patients can expect to interact with their health information in two ways--via a secure portal made available by the EHR vendor and the provider (another Stage 2 Meaningful Use requirement), or via a secure consumer e-mail account, similar to NHIN Direct.

The continuity of care document (CCD)

The vehicle used to carry personal health information is called a Continuity of Care Document (CCD). And, compared to earlier versions, the CCD specified for Stage 2 Meaningful Use is to receive a substantial upgrade in its capabilities, detailed in the "Consolidated" Clinical Document Architecture (C-CDA). C-CDA supersedes the Stage 1 CCD specifications and offers both developers and users a much more versatile platform for collecting, storing, and exchanging patient information.

The new CCD can be likened to a digital spreadsheet that contains a series of digital sections or "tabs," corresponding to the types of care being received and data being stored. In its present form, the CCD is a single document with many sections inside a common wrapper. So far, working groups have standardized the structure for eight sections of the C-CDA CCD, Lardiere said (See Figure 1).

CCD and header structure

History and Physical  Diagnostic Imaging

Consultation          Surgical Operation

Progress              Procedure

Discharge Summary     Unstructured (Text, Notes)

Figure 1. Conceptual view of a C-CDA Continuity of Care Document
(CCD). The latest Continuity of Care Document (CCD), based on the
Consolidated Clinical Document Architecture (C-CDA), is still
taking shape. At present, eight sections of the new CCD,
along with an overall structure, have been fully defined and more
than 70 new sections are being developed.

However, there is much more to do, said Lardiere. So far, more than 70 new sections are planned, dealing with everything from advance directives and allergies to social history and vital signs. …

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