My Favorite Day at HIMSS11

Tuesday, February 22 was my favorite day at HIMSS11. I watched a scenario that demonstrated the future of health information exchange at the Interoperability Showcase-but it was live and happening today. This year the Showcase featured the introduction of a third theater, Theater C, purposed for live demonstrations and special lectures for a large audience. Previously, the only option to see interoperability in action was to take one of the docent-led tours at the Showcase. Tours with a small group of attendees moved from one vendor table to another in a series of steps orchestrated to demonstrate a particular exchange scenario. Theater C brought the vendors to the audience instead. This innovation was wildly popular with Interoperability Showcase attendees.


Two EHR software vendors, Allscripts and Epic, participated in the scenario that impressed me. The first step was creation of a clinic note for an outpatient visit. This of course is passé for EHR systems, but then the magic started. A CCD summary document was created for the visit with just a few mouse clicks. Next, a referral was made to a cardiologist. This entailed pulling up a referral form to which the CCD was attached. The referral was then transmitted to the cardiologist's office using the just-released Direct (Direct Project) specification software. The sequence seemed to be nearly as easy as sending email. Recall that the purpose of the Direct Project was to develop software to enable point-to-point health information exchange in secure fashion over the Internet. My understanding is that with this design, only the envelop with the address information is visible to intermediate internet service providers. The contents, the health information, are encrypted during transmission. An exchange of certificates (used in keys in accordance with Public Key Infrastructure) is necessary to encrypt and decrypt the clinical information at either end.

The second EHR vendor's software was used in the cardiology office. Here, the cardiologist performed and documented the specialist visit. A new cardiac medication was prescribed and a new medication allergy was recorded. The medication list was reconciled against the list of medications in the CCD sent by the primary physician. Finally, a new CCD was created for the cardiology visit. The workflow was as seamless and simple as with the first vendor's EHR software.

The scenario included a transfer of care to a new primary physician needed because of a change in the patient's insurance coverage. The cardiologist's CCD was sent using Direct to the third physician office. Here, the physician's staff pre-populated the patient's new chart before the patient visit by importing data extracted from the CCD. The patient would not need to fill out history forms before the appointment and the physician would not have to enter the data into the new chart. Most of the patient's history would just need to be verified during the first visit. One can easily see how this would improve the efficiency of care and increase the satisfaction of both the patient and physician for the office visit. Most impressive for me was that both vendors have taken a software specification that was only announced a couple of weeks ago and have incorporated it and the associated workflows into their EHR systems already. (I suspect they participated in development of the Direct Project. This shows the benefit of vendor participation in public standards and interoperability activities.) I don't think it will be long before patches or updates are marketed to their customers. This sets the bar for competitors. I think we are poised for an explosion of health information exchange.

I have been a docent at the Interoperability Showcase for the last three years. I find it educational to take a tour myself occasionally. I was especially impressed by a tour I went on that demonstrated a public health scenario for newborn hearing screening. The scenario highlighted a new IHE profile that was just tested at the IHE North American Connectathon last month in Chicago. (I helped test the RFD portion of the profile.) So this was truly cutting edge technology. The profile utilizes many advanced features: generating EHR records and summary documents for mother and child (Patient Care Coordination domain), automated patient care device data capture (Patient Care Device domain), and request form for data capture (RFD-ITI infrastructure domain) with capability to pre-populate a public health form by extracting demographic data and available clinical information from the EHR. Bidirectional information exchange between provider and a public health entity is required. Finally, a clinical guideline in electronic format is used to provide clinical decision support to help a pediatrician provide the right care for a newborn with a hearing deficit.

I am convinced that the goals of improving health care through the use of health IT are not just a pipe dream. The solutions are out there being tested and demonstrated today. If you haven't ever gone to the HIMSS Interoperability Showcase, you have really missed something unique. This is where the vanguards of technology and innovation can be seen working together harmoniously. There is really no other way to see so much in one place except perhaps by attending the IHE Connectathon Conference or working at the Connectathon.