View Point One: Clinical data exchanges with clinics can wait.

"Getting the internal workflow right first must be the priority before extending outside the four walls of a healthcare organization."

  • Only 13% of physician practices use basic electronic medical record (EMR) software to store clinical notes, order prescriptions, and view lab and imaging results (Giving Health Care a Dose of IT, Baseline, January 23, 2009). With such a small percentage, there is no sense of urgency in developing the infrastructure to support electronic clinical data exchanges with physician practices. There is no reason to build a bridge to nowhere.
  • Internal healthcare workflows need to be addressed first. There is much more efficiency to be gained by automating internal workflows and implementing fully, an integrated data flow between the various applications within a healthcare organization. A strong internal healthcare workflow and data flow will provide the right foundation for exchanging data with clinics.
  • There are so many issues that need to be resolved prior to exchanging patient information with outside clinics. For example, what is the unique patient identifier or medical record number? How will the mapping of patient identifiers be handled effectively, ensuring a strong match? Health Information Exchanges (HIEs) sound good on paper, but implementing them takes much effort. Working the workflow issues between external physician practices and internal data requirements is the starting point – process first, then people (i.e., patients) and technology.
  • Expensive – sure there are incentives, but will the costs outweigh the benefits? According to a recent article, 10% of physician groups in Arizona who have an installed EMR are cancelling their contracts and reverting to paper. Getting an EMR installed and working efficiently and productively should be the priority, not connecting outside the four walls. Again, it is important to "walk before running."

View Point Two: Clinical data exchanges with clinics can't wait.

"With clear focus on the patient information at the clinic, quality of care is enhanced, and much efficiency is gained."

  • Quality of patient care comes first, and gaining a complete, integrated health record must be the priority. Paper medical records are not accessible by the various physicians involved in delivering patient care. A complete – as much as possible – health record can only begin when the patient information is available electronically and can be quickly and easily exchanged between applications and with other providers of care.
  • With paper processes, inefficiencies in the delivery of care are abundant. It is time to take significant costs out healthcare while enhancing the quality of care. Today, a patient may get a blood test from one doctor. Two weeks later, the same patient may see a specialist and, frequently, the specialist will perform another blood test because the information from the first is inaccessible. Connecting applications together to exchange critical patient information will reduce the costs of delivering quality care to patients.
  • And, yes, there are incentives to do it now. Although that should not be the primary reason to implement new technology and approaches, it does provide a sense of urgency to stop talking about it and move forward with implementations. Clinical data exchanges will enable physicians to enhance the quality of their work, deliver greater information into the hands of patients, and enable the necessary cost efficiencies that we need in our healthcare cost structure.
  • The workflow and patient identification challenges can be addressed and resolved with the right attention and sense of urgency. Innovative, practical healthcare integration platforms and supporting technology exists today. Leveraging technology to connect clinics, hospitals, labs, and radiology practices is creating real value today. Additionally, the new incentives will start soon, so waiting is no longer an option. The definition of "meaningful use" is not complete, but the direction is clear enough to begin work now. Waiting is not a viable option, especially when considering the quality of care enhancements, the achievable health care cost reductions, and the incentives to move forward today.


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