Over the past few weeks I’ve been talking to a selection of our customers about importing external data into their electronic medical records systems.

At eHealth Technologies we process millions of pages of electronic records per year. Much of this data continues to be delivered via fax, a protocol that I have laughingly termed the default transfer syntax of healthcare. As we move forward we are looking to incorporate more electronic documents including clinical document architecture (CDA).

The conversations have been interesting.

While I can’t share too much detail about the customers whom I interviewed, they ranged from a very large IDN to a midscale hospital. A range of IT, clinical, and administration staff were included so that I got a balanced view. There was a definite bias towards interviewing people who actually do the work so that I got a hands-on perspective.

My question was relatively simple. Would you be willing to ingest structured data for continuity of care from a clearinghouse?

The answer to this question was overwhelmingly no. Participants felt that there was little uniformity in continuity of care documents, and it was unlikely that a document that worked in one system would be able to be successfully used in another system. They would be willing to attach the CCD, but not to import it.

As a certified HL7 CDA Specialist I tried to reassure them that the vast majority of the content in the CCD would be available. This didn’t assuage their fears and a lively conversation about liability ensued. Who was liable that the data is correct? Should the receiving institution quality assure the data when it arrived, and how would they do that without a physician reviewing it? How would they handle discrepancies? What would happen if they incorrectly handled a discrepancy?

What’s interesting about these arguments is that each hospital had certified for meaningful use stage two and are subject to core requirements that they have met in their EMR. There’s a good chance that they are in fact actually using some CDA documents already, but only in the very prescribed use cases needed to gain federal dollars.

Importing CDA was not a high priority for any of these customers. They all have too many IT projects underway and very limited budgets. Having to certify yet another system is not something they would be willing to do at this point in time.

It would seem that we will be stuck with using unstructured external data in healthcare for quite some time.

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