This Data Exchange Framework Sets the Bar High

In Massachusetts, a service used for securely sharing data between physicians and emergency departments is being called a "game changer."

In the battle to reduce hospital admissions and readmissions, the struggle to share information remains on the front lines.

But in Massachusetts, data-sharing arrangements between physicians and emergency departments are making progress. One example is Worcester-based Reliant Medical Group, a multi-specialty group practice with more than 500 providers.

If a patient of one of Reliant's physicians arrives in an emergency department at nearby Saint Vincent Hospital or Milford Regional Medical Center, the EHR systems of those EDs will automatically generate and send a message to the physician.

Within 90 seconds, Reliant's EHR automatically sends a summary of the patient's medical record to the ED via the DirectTrust service. 

In this way, ED docs alert these Reliant physicians, and in return gain access to valuable medical history, medication, and allergy lists on the patients they are treating.

"One of the biggest game changers for us is the ability not just to be able to exchange information with other organizations, but to do it in a hassle-free way that doesn't require a lot of effort by the users," says Larry Garber MD, associate director of research and an internist at Reliant.

"Nobody has to do anything other than what they always do, which is registering the patient," he says. "Ninety seconds later," the emergency room doc sees an icon on the bed board "saying this patient has outside records from Reliant Medical Group."

Easy Expansion
By the end of the year, Reliant will extend such relationships to three additional hospitals in central Massachusetts. Expansion within and even outside the Commonwealth, to destinations where Massachusetts "snowbirds" land during the winter months, is relatively easy.

A key enabler of this connectivity is the DirectTrust "trust framework" which securely connects EHRs via health information service providers (HISPs), and sends Direct messages, but which also enables something called its Directory Data Aggregation Service.

Direct Protocol May Favor Large Providers and Vendors

This connects some dots: Every certified EHR must be able to send and receive Direct messages, but the government never built a provider directory so that those EHRs or their users could look up the Direct addresses of individual physicians.

Leveraging DirectTrust, participating providers can perform such directory lookups and enable the workflow Reliant and its partners are leveraging.

One Direct messaging shortcoming is that physicians must set up multiple Direct mailboxes, due to the fact they may split their time among their practice offices, hospitals where they may be attending physicians, and other locations throughout the day.

How is a sender supposed to know which of those mailboxes to use? Garber says that within Massachusetts, the state HIE, the Massachusetts Health Information HIway, plays a role in dealing with this problem.

Sending is Not Like Receiving
As mentioned above, all EHR software is capable of sending Direct messages as part of meeting the meaningful use requirements. But configuring an EHR to send Direct messages is different than configuring an EHR to receive Direct messages, Garber says.

"A lot of EHRs, when the message comes in, it goes to some generic pool that some medical records person has to be staffing to figure out which patient is this and who should I send it to, and that really becomes an obstacle," he says.

To solve this, Reliant uses the Mass HIway's Local Adaptor for Network Distribution (LAND) technology, which takes a Direct message and converts it into formatted text ready to be loaded into Reliant's EHR and from where the message can be routed to the appropriate Direct mailbox of the patient's appropriate physician, Garber says.

Ultimately, Garber hopes that EHR software itself becomes smart enough to carry with it the necessary provider directory and associated technology to make all this simple and automatic.

Not all providers belong to DirectTrust, and the lion's share of providers, of course, are not in Massachusetts (think of where those snowbirds may receive emergency care) and don't have LAND to help.

It remains to be seen exactly how and where the remaining dots will be connected to similarly improve patient ER visits everywhere.