Over the past few days I’ve been pondering the growth of what I term the “closed user group networks of healthcare” such as Epic CareEverywhere. While on the surface these groups offer compelling stories about being able to retrieve records from participating hospitals, I’m always left with one fundamental question that remains unanswered.

“What did I miss?”

Are there records out there that are important to the patient’s care that I don’t know about? Was a PET/CT scan performed out of network, or did the patient have a round of chemo through a non-participating facility? These are questions that I just can’t answer when all I have to rely on is a “closed user group”.

Don’t assume that you can turn to the patient to answer the question either, for as we know, patients are rarely the best historians of their own health, and memory is a fallible tool. At eHealth Technologies we are often asked to search for patient records based only on a brief description of the facility, and some identifying landmark such as a blue awning. These are records that you’ll surely miss if you rely only on a closed user group, and the facility is not a participant.

If all the data you want is in your network, or your patient has only been to major hospitals in the area and their affiliates then you will get some of the data you need from the closed user group, but remember, even this data has been setup to meet the needs of meaningful use and is typically the minimal summary set needed to achieve the federal rules. What did you miss by not getting the full record? You’ll never know.

You could argue that having multiple closed user groups that cover a large percentage of your geographical area might provide more assurance. Unfortunately, now you have multiple systems to log into, and the rather nasty task of reconciling a large amount of information into something that a doctor can actually read, let alone something your legal team will allow you to put in the EMR. Even then, what did you miss?

The reality of today’s world is that closed user groups such as CareEverywhere are not ready for prime time in complex areas such as oncology and transplant, and records retrieval services still have a role to play in collecting data, and turning it into useful information in the form of disease specific clinically curated summaries.

The last thing that a physician needs is to be continually asking themselves the question — “what did I miss?”.

One thought

  1. This is a very compelling article. Though your general interest in incorporating a more open and versatile healthcare network protocol is superb, in what ways would you attempt to implement such a large-scale task? I too feel that the use of a closed network is less than optimal when patients can just as easily visit a well known and respected hospital just as they could an obscure physician’s office, the physicians office of which may have found something critical to the long-term care plan for said patient, but the next treating physician may be unable to obtain those records due to the overall obscurity of the initial facility.

    When a facility chooses to implement a seemingly efficient closed network, that facility is then losing the opportunity to provide the best, most personalized care for the patient. But, the only way to abolish the potential crises at hand is to somehow rid the healthcare network of closed network groups, which is nearly impossible. One strategy could be to establish a network of which consolidates all other networks, but the end result would be the same; a closed network that will, at some point in time, fail to provide the best patient care due to medical records, or lack thereof.

    In my opinion, network consolidation would be the best option, as it would decrease the amount of systems one would be required to access – something that would also lessen the ‘HIPAA stringency’ of the entire operation. Network consolidation would also alleviate the need to contact many different healthcare facilities only to result in receiving the same exact records, ultimately facilitating a more organized environment. A network consolidation would also require an intuitive, brilliant, strategical sales team that has the capability to convince all facilities not within the network to join, which is going to be a tough matter for all small, independent doctor’s offices. Although, with opinionated perfection comes many disguised incidents. The overall strategy would require a near perfect system to account for emerging healthcare providers as well as facilities that will no longer be operational. The network would require an extremely large I.T. Infrastructure to accommodate the many, many system errors that will occur on a daily basis. Overall, the network would require an open-minded director that has a passion for the project, and is will to give it his/her all from commencement to completion.

    So, once again, what is your opinion of this matter, regarding the removal of closed networks, or consolidating all closed networks? If you have time to answer, do you consider my strategy to be somewhat of a rectification or a potential landslide, if you will.

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