Healthcare Interoperability

What did I miss?

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?”.