Over the past 20 years, the U.S. government has struggled to apply standards across the country's highly complex, fragmented health care system to combat its inefficiency, waste, and preponderance of medical error. Part of the solution has been the nationwide implementation of an interoperable health information technology (HIT) infrastructure to improve the quality and efficiency of healthcare and encourage integration and information exchange among healthcare providers through the use of a health information exchange (HIE): two or more organizations sharing patient medical information using the same technology and standards.

There is tangible evidence that HIEs are gaining widespread adoption. A report released by the eHealth Initiative, Fifth Annual Survey of Health Information Exchange at the State and Local Levels, reflecting a poll of 130 community-based initiatives in 48 states, revealed significant advances in HIEs. The report also documents a 30 percent increase in the number of operational HIEs over last year.¹

In many ways, emergency departments have gotten lost in this technological transformation because ED staff members usually work in isolation from other clinicians in the medical community, heightening the need for adoption of electronic health records (EHRs). There is a sense of urgency, particularly in light of the rise in ED visits: 119.2 million ED visits in 2006, an increase of 36 percent in the course of a decade.²

That means an increased number of patients coming to the ED without the benefit of an integrated electronic record detailing their medical history, and who are unable to efficiently and accurately share treatment information during and post-ED care.

As it is, an ED visit is often a one-time encounter, which does not offer continuity of treatment based on a patient's medical history. So the goal for ED health care providers becomes not one of how to control the rising burden, but rather of maximizing this point of contact for each patient.

The solution to this challenge lies in a single-source portal that provides patient information at every touch point of the health care continuum. As a result, all care providers have access to a comprehensive view of a patient's medical information, with data that has been aggregated from multiple sources. Today, the emergence of this type of system is able to leverage existing technology, with functionality that ensures seamless communications across all hospital systems. In the ED - where every minute counts - this instant access and real-time communication is vital.

Case Example: Health Information Exchange of Montana (HIEM)

Specifically, this type of single-source solution has transformed the functionality of the Health Information Exchange of Montana (HIEM). While HIEM received a large percent of its ED patients via helicopter, which gave the medical staff time to gather medical history, one problem remained: details about the care given in the ED was not traveling seamlessly as the patient moved into the wider medical community.

To solve this challenge, HIEM contracted with technology partner for a single-source solution to consolidate patient data from existing clinical information systems in medical facilities throughout a 45,000 square-mile area in western Montana. The goal: improve quality, reduce duplication of effort, and facilitate communication across treatment settings.

Having a complete picture of a patient allows clinicians in disparate systems to understand the unique nuances of each individual and better manage acute conditions. This single-source solution relieves the burden of logging on to five or more systems to accumulate information on one patient. With a single view of patient data from the various treatment settings in the area, clinicians are better prepared for a patient’s arrival at the ED and able to coordinate follow-up care.

The HIEM uses the CareAlign solution from the Informatics Corporation of America (ICA) to integrate demographic, appointment, admission, discharge and transfer information with clinical data from laboratory, microbiology, blood bank, pathology, inpatient and outpatient encounter summaries, medication lists, allergies, EKGs, clinical imaging, PACs, quality indicators, and other clinical documents. This robust scope of data and information is embodied in a single-source, cognitive tool that supports physicians and other clinicians at the point of care. As patients naturally navigate through the local health care system, their relevant health care information follows them from treatment setting to treatment setting.

What to Look For in a Single-Source Solution

Implementing single-source HIT is about data integration that allows software sharing so that patient information doesn't fall through the cracks.

The best solutions offer an open structure and the ability within the application to gain a quick link to the ED physician to access test results and medical history. Additionally, any diagnostic pieces that are tied into a solution should become instantly available and dynamically linked into the ED, while also allowing an ED discharge summary to be available within the hospital system and out to the ambulatory healthcare world.

Such solutions should add value to -- rather than replacing -- the investments hospitals have made in legacy systems over decades of purchasing. By aggregating data from existing sources to create a unified electronic health record, clinicians have a view of all the data they need to make informed decisions during patient encounters. This accumulation of comprehensive health data across treatment settings allows patient-centric dashboards to be tailored to diseases and medical conditions, providing true cognitive support for physicians at the point of care.

This ability minimizes upheaval and serves the "green" movement by mitigating waste and saving time, resources, and cost - while reducing the staff learning curve. This kind of technology solution also offers a change that can be embraced by every health care provider because it requires minimal training before they are up and running on the system. Beyond that, ED managers should make sure the solution allows the care team to

• View medical history in the ED to make decisions about the patient's current condition

• Secure clinical messaging to aid in collaboration within the ED and coordination of follow-up care post discharge with primary care and specialty physicians

• View medical history on admission at every touch point regarding the patient's ED experience

Of utmost importance, a single-solution technology must work with all health care software systems. In terms of accessing information from the ED - whether or not it's automated - health care facilities can opt for system to system integration, electronic access to documents, or document scans that can be transferred electronically.

Conclusion

The current administration is preparing to spend billions on health care technology to find solutions with added value and that incrementally improve the physician's ability to provide care, not simply automate current processes. The best solutions on the market break down silos of information to deliver a comprehensive longitudinal medical record viewable by all health care organizations within the community. It's the next evolution of providing every member of a health care team the information they need, when they need it, so that they can deliver optimal care.

John Tempesco is vice president of Client Services, ICA.

^{1. Manos D. eHI report shows growth in health data exchanges; Healthcare IT News; September 29, 2008; http://www.healthcareitnews.com/news/ehi-report-shows-growth-health-data-exchanges. Accessed May 13, 2009.}

^{2. Burt CW, Niska RW., et al. U.S. Department of Health and Human Services; National Hospital Ambulatory Medical Care Survey: 2006 Emergency Department Summary; Number 7 - August 6, 2008. http://74.125.95.132/search?q=cache:9Y6I1cc9JWAJ:www.cdc.gov/nchs/data/nhsr/nhsr007.pdf+emergency+room+visits+statistics&cd=2&hl=en&ct=clnk&gl=us. Accessed May 11, 2009.}

About Informatics Corporation of America (ICA)

Informatics Corporation of America (ICA) was formed to take innovative technology developed by practicing clinicians and informatics professionals at Vanderbilt Medical Center to the broader healthcare market. ICA's solution enables interoperability of existing hospital and clinic systems to deliver a comprehensive electronic health record and tools ranging from a physician portal to secure messaging to disease dashboards. By providing clinicians with a comprehensive longitudinal patient record, ICA empowers caregivers to make informed decisions at the point of care, helps healthcare enterprises achieve operational efficiencies, and facilitates patient care across multiple providers and settings.

For more information, visit www.icainformatics.com.