By John D. Halamka
The Centers for Medicare & Medicaid Services (CMS) has long required that hospital and professional records be separable so that, in the case of audits or subpoenas, it is clear who recorded what. However, as patient-centered medical homes and accountable care organizations (ACOs) form, the lines between professional and hospital practices are becoming increasingly murky.
Today, the Beth Israel Deaconess Medical Center ACO continues to expand into the community, adding owned hospitals, affiliated hospitals, owned practices, and affiliated practices. Our strategy to date has been to use our home-built inpatient and ambulatory systems at the academic medical center, a proprietary system in the community hospitals, and a second vendor-provided system in the private ambulatory practices that are part of our ACO.
We share data among these electronic health record (EHR) applications via private and public health information exchange (HIE) transactions-viewing, pushing, and pulling (see the sidebar at the end of this article).
The challenge with emerging ACOs is that professionals are likely to work in a variety of locations, each of which may have different IT systems and each of which serves as a separate steward of the medical record from CMS's point of view.
Our clinicians are asking the interesting question, "Can I use a single EHR for all patients I see regardless of the location I see them?" Our legal experts are studying this question. I can imagine several answers:
Since it is unlikely that every inpatient and outpatient facility that we acquire or affiliate with will have the same health information systems and EHR applications, it is not realistic to create one physical shared record across all sites. Instead, data sharing through the HIE, metadata tagging as to the facility/professional that owns each record, and policies regarding what must be done at each site seems like the logical way to go.
John D. Halamka, MD, MS, is CIO, Beth Israel Deaconess Medical Center, Boston, and chairman of the New England Healthcare Exchange Network (firstname.lastname@example.org).
This column is reprinted with permission from his blog, Life as a Healthcare CIO.
View. A website or web service enables authorized patients, providers, or payers to view data in plain text or HTML.
Push. An EHR sends data to another EHR via the Direct Project standard.
Pull. An EHR queries a master patient index/record locator service to identify a patient and the patient's records. The EHR then queries all the data sources to assemble a comprehensive medical history.
Somnia: Bending the Healthcare Cost Curve Toward Improved Anesthesia Value
PMMC: Navigating Revenue Cycle Management Challenges as Value Based Purchasing Emerges
Burgess: Simplify the Business of Healthcare
J.P. Morgan: Managing Cybersecurity and Protecting Patient Data
Brian DiPietro, Managing Director, Commercial Bank Technology, JPMorgan Chase & Co., discusses the importance of evaluating your cybersecurity protocols to help prevent malicious data breaches.
TransUnion Healthcare: Smarter Revenue Cycle Solutions
Gerry McCarthy, President of TransUnion Healthcare, discusses industry trends contributing to higher bad debt and what to do about them. Gerry is responsible for the strategic direction of the healthcare business and expanding its footprint in the healthcare market overall. He has more than 20 years of experience in healthcare information technologies.
Deloitte: Creating Value with Effective Care Management
Scott Kolesar, principal and senior leader in Deloitte Consulting LLP's Value Based Care practice, and David Wennberg, MD, MPH, adjunct associate professor of The Dartmouth Institute and former chief executive officer, Northern New England Accountable Care Collaborative, discuss the challenges and competencies involved in creating a care management organization.
American Express: Streamlining Supplier Payments and Boosting Revenue
Andrew Jamison, vice president in the Global Corporate Payments division of American Express, discusses trends and opportunities in supplier payments.
Deloitte: Realizing the Potential of Your CDI Program
Suzanne Whitworth, director at Deloitte & Touche LLP, and LaVerne Romberger, MSN, CCM, CCDS, clinical operations manager-Seton Healthcare, share leading practices for maximizing the potential of clinical documentation programs under value-based care.
RevSpring: Customizing a Technology Platform to Drive Patient Payment
Martin Callahan, Senior Vice President, Healthcare Solutions, RevSpring, describes key industry trends affecting how patients engage with the revenue cycle and ways payment processes are changing as a result.