September 14, 2009

Reconciliation-an unmet challenge

There is little doubt that in the near future, more electronic clinical information will be shared between providers using established standards and various methods of information exchange. The goal is to provide the most accurate, up-to-date information to the clinician, when it is needed. An associated benefit for patients is that they will not have to fill out redundant forms. However, a new problem is about to be created. Multiple sources of information will be available to clinicians. The data will need to be collected, sorted, aggregated, de-duplicated and reformatted to serve as the source of truth for patient care. Clinicians will want this process to be automated, as much as possible. They will not want to have to click through multiple screens and scroll through pages of data. The final report will need to be reviewed with patients to verify accuracy whenever possible.
What types of information will need to be reconciled? As one starts thinking about this question, the list of possible answers seems to grow. Examples include: medications, laboratory reports, CCD documents, and administrative information. Consumer preferences for information release and advanced directives will be areas that it will be especially important to keep up to date. They have been mentioned as priorities by the Office of the National Coordinator for Health IT.
There will be multiple steps in the process. Location(s) where data is stored will need to be identified. Next the data must be imported (via a push or pull transport mechanism) and stored. Then the sorting process will occur that harmonizes all the data that is available. Finally, a report of the most accurate, up-to-date data will be presented to the clinician to review with the patient. Ideally, this would be a one click activity. All the decision rules would need to be incorporated into software to automate the process. (The banking world has developed a similar capability but their data does not have the variety of data elements that is seen in health care.)
In the inpatient setting, this would be used with every transfer of care between providers in the hospital. The transition from inpatient care to ambulatory care is an especially important area when reconciliation of electronic medical records must occur. Finally, in the ambulatory setting, reconciliation will be necessary when patients travel from one provider to another.
A good question is whether a potent, general type of software might be used to process all the different types of data- "the reconciliator" or whether multiple varieties of specialized software will be needed for each type of message/document. I suspect that the latter will need to be the choice. A special case may be the reconciliation of CCD documents. Here, if the software is designed around all the CCD sections, the data types and vocabularies will be standardized so complete CCDs and their summaries might easily be reconciled by one piece of software. It is imperative for EMR vendors and their engineers to address this important emerging EMR capability.