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The EHR: Interoperability

Interoperability: improving continuity of care

Interoperability is the main focus on Meaningful Use Stage 2. The goal is to improve the quality and efficiencies of healthcare. Participating providers electronically exchange key clinical data with clinics, imaging centers and laboratories. Establishing connectivity to a health information exchange (HIE) creates tremendous research capabilities for health researchers, resulting to capturing and tracking health trends and improve outcomes.

Ulrich Medical Concepts: Dr. Mostashari

At the HIMSS Conference, Fazad Mostashari, MD, visits UMC’s exhibit, “Physicians EHR Reporting to a Central Cancer Registry.” He and other visitors saw step-by-step how the clinical data is transmitted in real-time, from documentation of the initial patient encounter in Team Chart Concept to submitting the cancer data to the Kentucky Cancer Registry.

Implementing electronic health records (EHR) interfaces is not an easy task. Before the 2013 Healthcare Information and Management Systems Society (HIMSS) Conference, ONC Chief Farzad Mostashari,MD, told Health IT News, HIE is a shared responsibility.

“Fundamentally, we have to reduce the cost and complexity of interfaces through standards and implantation guides,” stated Mostashari. “The vendors have to really be able to do Stage 2. It’s a huge step up—huge step up on interoperability. Vendors are really going to have to step up to the plate in terms of being able to achieve the Stage 2 expectations for true vendor-to vendor coded, clinical structured, documents being able to have kind of ubiquitous protocols with security in place.”


UMC your vendor and partner for established connectivity

At the HIMSS Conference, Ulrich Medical Concepts (UMC) president Sandra Ulrich co-presented “Overcoming Barriers to Public Reporting. The presentation highlighted how UMC, the Kentucky Regional Extension Center (REC) and Paducah Dermatology PLLC partnered to achieve the nation’s first “real –time” EHR based model that successfully reports cancer cases to the Kentucky Cancer Registry (KCR).

“This project is laying the ground work for electronic reporting, not only in Kentucky, but across the U.S.” said Ulrich. “We were honored to have ‘first in the nation’ status to participate in such a cutting-edge project.”

Paducah Dermatology, PLLC was already using UMC’s EHR, Team Chart Concept (TCC), before the project began. Collecting much of the required data through TCC, the data still needed to be mapped into the clinical document architecture (CDA).

Because the CDA format was in its infancy when the collaboration began, UMC had a positive opportunity to have an input from a vendor perspective. As the standard evolved, adjustments to the data sent in the CDA were required, including:

  • Adding new fields; and
  • Modifying previous added fields.

There was no existing connectivity with the Kentucky Health Information Exchange (KHIE). UMC developed the ability to communicate with KHIE using secure “web services.”

This involved:

  • Developing the proper communication protocols to ensure secure deliver of the protected health information; and
  • Software development to transmit the CDA document in the requested HL7 message.

"A key thing for our office is that we have an EHR and a vendor that worked with us and helped us through this entire process,” said Robin Stamper, practice manager for Paducah Dermatology.

The successful model proves that it is technically feasible for state cancer registries to receive standardized cancer data from physician EHRs.

“From the KCR’s perspective, we can anticipate receiving reliable, high quality data from physicians using TCC, that fulfills our reporting requirements,” said Eric Durbin, director of Cancer Informatics at the KCR.

“UMC has been a great partner,” said Durbin. “We could not have been successful in this project without their support. Their hard work and dedication has helped draw national attention to our highly successful collaboration.”

TCC users are able to interface with:

  • Clinics
  • Hospitals
  • Imaging Centers; and
  • Laboratories.