The advent of true interoperability: Sharing actionable patient information across systems

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Dr. Joseph DiPoala is no stranger to electronic medical records (EMRs) and how important technology is in driving effective and insightful communication.

Co-founder of Ridgeview Internal Medicine Group, a four-physician, three-advanced provider practice in Rochester, New York, Dr. DiPoala also knows what a hassle it is to wrangle patient data from siloed sources. Not only does it take time away from patient interactions, but also increases the risk that critical data could be missed, potentially leading to less-effective treatment.

For the past 17 years, Ridgeview has thrived as a private practice. However, remaining independent comes with its challenges: Ridgeview needed to leverage interoperable technologies able to effectively communicate with other systems and share patient information.

Today, Ridgeview is empowered to connect across disparate systems, leveraging athenahealth’s Patient Record Sharing service to communicate with local large systems via CommonWell and Carequality and exchange medical information instantly. This ensures physicians have the appropriate information at the point of care and that this information follows the patient, no matter the care site. Below, he outlines how the new capability has helped fill patient information gaps during day-to-day interactions.

Q: Historically, what has been Ridgeview’s experience with sharing information with outside organizations?

A: We have had the good fortune of having an extremely well-established health information exchange (HIE) in our community with a high participation rate—but there are definitely gaps in terms of the documents that we can receive. For example, when patients get treatment in an outpatient setting for Rochester General, our main referring hospital, those records aren’t accessible through the HIE—this has been a pain point for the past three or four years. Prior to using a record sharing service, we also struggled to onboard new patients because we were unable view complete records that included previous medications and immunizations. We frequently received faxed documents and were unable to input the patient data directly from the continuity of care document (CCD). The process was a nightmare.

Q: As you mentioned, locating previous health data when onboarding a new patient is critical. What was your approach to gathering patient information before a visit?

A: Before having access to the full patient record, we received information through three sources:

• The paper medical history form patients complete when they come in: After check-in, my nurse or myself would have to transcribe the data from that paper document into the EHR.
• Records from previous visits: This was a huge tech hassle. Scanning Epic’s system—if we even had access—to find the right documents, print them out, and scan them into our system was inefficient and time-consuming. It then required a significant lift to search through the records by hand to try and identify the right information.
• Information-gathering when meeting patients for the first time: This involved filling in any gaps in the information obtained in the first two steps, and was extremely labor-intensive.

Q: What do you think is most valuable about increased interoperability?

A: Two things: First, sharing records eliminates much of the above difficulties, fills in gaps in medical histories and ensuring accurate diagnosis and treatment. Second, it brings in structured data through the reconciliation process. This way, when we see a new patient, we can not only view her records, but also import the problem, allergy, medication, and immunization lists. You can’t successfully accomplish that sort of reconciliation solely relying on faxes, information from our HIE, or other sources.

Q: Who are you exchanging records with most often? Who is benefitting from increased connectivity?

A: There are two major health systems in Rochester: Rochester Regional Health (of which Rochester General is a part) and University of Rochester Medical Center. Patient Record Sharing has allowed us to communicate with Rochester General seamlessly and, conveniently, University of Rochester Medical Center joined the network about a month or two ago. It’s been fantastic—there are only two big systems in town, and we can share records with both of them.

Q: How has exchanging patient records across systems and geographies helped you improve care coordination?

A: There is one area in particular where this has proven to be extremely valuable: When one of my patients visits the ED at Rochester General (our affiliated hospital) or at the University of Rochester Medical Center, the ED physician can see what I see as I’m able to share the record. There is peace of mind for the patient knowing no matter where they go or who they see, the physician will have access to their CCD created by athenahealth.

Q: How is interoperability key in helping you remain an independent practice?

A: For an independent practice, efficiency is critical—whenever you’re able to identify areas of inefficiency and take the appropriate steps to rectify, you’re in a better place. And now, with the ability to communicate with those around us, we’re in a much better place. Prior to sharing records, our process for securing the appropriate information at the point of care was timely and burdensome, taking physicians’ time away from focusing on the patients at hand. This is no longer the case: Instead of spending valuable time searching for missing documents and suffering from heightened, unnecessary workloads, our doctors can use that time to deliver quality care to patients.

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