Jun 10, 2016/By Mark Belanger

All give and no take

Observations on roll-out of statewide health information exchange in Massachusetts

It is a funny time in the world of health information exchange here in Massachusetts as the Mass HIway enters its fourth year of rolling out direct messaging statewide. There are some healthcare providers that are way out front. The kinds of things they think about are:

  • How do we move patient information in a way that can save more lives? Whether that be to the ED or even to the ambulances.
  • How can we set up trust, triggers, and transport in a way that lets the computers move information around before the clinicians even know they need it?
  • What is the next generation of the care summary and how can we innovate to help our clinicians distinguish the signal from the noise?
  • How can we efficiently put clinical and quality information together to support our jump into value based purchasing contracts?

But there are only a few way out in front. Those providers in the healthcare system transformation “Peloton” are still in the throes of Meaningful Use and its peculiarities. The kinds of things they think about are:

  • Where can I send care summaries to make our TOC thresholds?
  • Who is connected to me and how?
  • How can I address the message?
  • What the heck am I sending? Can I review it before it goes out? Can I choose what goes in and what is redacted?
  • How are we going to be sure we don’t inadvertently disclose sensitive information without proper patient permission?
  • Numerators and denominators and attestation

The peculiar part of this time is that most of the provider focus is on sending information without equal and opposite attention to receiving. And I think that is ok – for a little while. We need this “tweener time” when everyone focuses very practically on all the hard policies, technology, and workflow changes to move patient information out through electronic channels.

But what to do with the receiving end of the line during the tweener time?

Here are some good ideas that are happening that are not working particularly well on the receiving side:

  • Trying to remain “unlisted” in provider directories so no one can find our clinician addresses
  • Setting up auto replies that tell senders “thank you very much for the information but we are not ready to use it yet [and we don’t want the associated liability for using/or not using your information]”
  • Delaying sending care summaries until we are also ready to receive

One approach is working pretty well to date. Several organizations are talking to one another prior to sending any clinical information electronically. They are agreeing to parallel send information through legacy channels. They are letting each other know that the patient information sent electronically will not be used during a transition and learning period. They are agreeing that there will be an agreed to hard “cutover” point when they will be using [and liable for] information received.

The tweener time is giving the organizations space to get the sending part right – and that is hard enough. They are then able to look at the information that is accumulating in the Inbox and systematically figure out how to deal with it. This means figuring out what their EHR [and perhaps integration] software can do and how to route information to departments and individuals. It also means opening the feedback channels to sending organizations to get them to improve their care summaries. [No clinicians have the time nor patience to review 90 page care summaries.]

Clearly there are weaknesses in this approach. Clinicians and attorneys alike don’t like to send and receive information that is just going to go to a holding tank and not going to be used. There are liability issues to be worked through. There are lots of catch-22 conversations to try to steer around. But the core argument is that we need a defined period of time to transition to electronic exchange of patient information and an “all give – no take” approach will tie the whole healthcare delivery system up for years.