Bringing Interoperability to Life
By Thomas J. Van Gilder, MD, JD, MPH, chief medical officer and vice president of informatics and analytics
This week we are celebrating the 10th Annual National Health IT Week (NHIT Week). NHIT Week is a collaborative forum and virtual awareness week that assembles key healthcare constituents dedicated to advancing health through the best use of information technology. In the spirit of NHIT Week, I would like to share a couple of personal experiences I have had as a clinician that highlight the power of available information—how bringing interoperability to life can improve outcomes, as well as experience and coordination of care.
Listen to your heart
I was managing the Cardiac Care Unit (CCU), an intensive care unit specializing in caring for those with unstable heart issues, evaluating a patient who was having a heart attack, when my pager went off. The Emergency Room (ER) “pit boss” (as we called the physician in charge of the ER that shift) was admitting a patient with chest pain to my service. He told me the patient’s electrocardiogram (EKG) looked “unusual” and so he assumed the chest pain was from the patient’s heart. Without an old EKG, evaluating my patient’s chest pain, which was atypical for a heart attack, would be difficult. Eventually, my intern found his old EKG. As I reviewed his old and new EKGs, which were identical, I asked the patient about his heart problems. He told me that he had had several evaluations and was told each time his heart wasn’t normal, but he wasn’t currently on any medications and hasn’t had any recent issues.
It was the 90’s after all!
I assumed, based on his history, my evaluation, and his old EKG being identical to the current EKG that his chest pain was not coming from his heart. As I was preparing to discharge him and arrange outpatient follow up, he mentioned that he had been to a nearby hospital recently because he felt “bad.” I contacted the nearby hospital and asked if they had an EKG from his recent visit. I was again surprised to hear that they did and that they could fax it to me. His more recent EKG told a different story. Though he had not been experiencing chest pain during that hospital visit, an EKG had been taken as a matter of routine. This EKG was dramatically different than the other two and suggested that, in fact, his chest pain might be from a serious heart condition. At that point, we admitted him to the CCU and did a full cardiac work up. His evaluation came out negative for heart problems and we ultimately ascribed his chest pain to stomach problems.
Fast forward to 2006
On a late Friday afternoon, at a suburban primary care practice: A woman was brought into the clinic complaining of chest pain, shortness of breath, and dizziness. She looked older than her recorded birthdate which I could view in her Electronic Health Record (EHR); the EHR also showed her smoking history. I thought she was certainly at high risk for having a heart attack. We performed the precautionary procedures for someone in danger of having a heart attack (oxygen, aspirin, heart monitoring, and blood tests) and called the paramedics for transportation to the local hospital. We obtained an EKG that was entered directly into the EHR and I was immediately able to review several older EKGs, along with their interpretations. Her current EKG was unchanged from previous ones; her preliminary lab tests were normal. Despite the results, we sent her to the hospital for further evaluation as a precautionary measure. I was reasonably confident she was not having a heart attack, and after further investigation, her ER doctors and her primary care team determined she was having a panic attack and treated her for anxiety.
Enable immediate interpretation
Health information exchanges (HIEs) require interoperability, but interoperability is about more than simply transferring data from one system to another. To bring value to individuals and their care teams, interoperability requires flexibility, portability, and the shared analysis of available data. In the first story, health information was indeed exchanged and altered the course of the patient work up. However, the information required manual extraction which added unnecessary and precious time to the analysis, leading to a potentially disastrous premature discharge. In the second story, previous EKGs were readily available, enabling immediate interpretations, at the point of care, which allowed a more effective and efficient use of medical resources. We were able to give the second patient the care she needed much more easily and quickly. Interoperability—the ability to share information across disparate information systems—helped us better coordinate an individual’s care, improve quality and enhance the overall care delivery experience. Interoperability is the backbone of effective, efficient health information exchange that enables improved outcomes across the care continuum.