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Getting Daisy Duck's Records Across State Lines? No Problem

March 21, 2013
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Common policies, processes and technical standards enable Direct secure e-mail to cross state lines

In a fictional scenario, a 77-year-old patient from Northern California named Daisy Duck is visiting family in Salem, Ore., and has shortness of breath. She goes to Salem Hospital and is diagnosed, admitted and treated for congestive heart failure. She is told to follow up with her primary care provider back in California. How easy is it for her primary care physician to quickly get the records from her hospital visit?  

Thousands of hours of work have gone into figuring out the technical and policy issues involved in developing a trust framework to exchange data with unaffiliated providers across state lines. Yet on March 20, when California Health eQuality (CHeQ) put on a webinar to demonstrate data being sent between providers in California and a hospital in Oregon using Direct messaging, nothing could have seemed more simple or straightforward.

The group doing the hard work to make this possible, the Western States Consortium, has now expanded beyond Western states to include 14 states. They have created a common set of policies, processes and technical standards for health information exchange using Direct ( secure e-mail across state lines.

“Providers become members of a 'trust community' when they agree to these common standards,” said Robert Cothren, technical director of CHeQ, a program of the Institute for Population Health Improvement within the UC Davis Health System, who led off the webinar.

What the webinar demonstrated was a limited use case of how a "trust community" of participating health care organizations can share patient information securely without the cost of establishing multiple point-to-point privacy, security, and technical protocols.

Features of the WSC trust environment include:

• Open standards-based query of provider directories using web services and the health information service provider (HISP) Provider Directory and HPDPlus data models.

• A common set of eligibility criteria and a "trust bundle" that permit all participating HISPs to immediately know with whom they can exchange messages.

Back to Daisy Duck.  In the March 20 webinar, Chris Jioras, IT department manager for North Coast Health Information Network in Humboldt County, playing that primary care provider, demonstrated how a federated search of California and Oregon provider directories allowed her to find the Salem Hospital medical records and place a request for the discharge summary. Sharon Wentz, R.N., business development coordinator for Oregon's HIE, CareAccord, playing the role of Salem Hospital records staff, fulfilled the request with a simple e-mail attachment.

Later, Will Ross, project manager for Redwood MedNet, an HIE in Ukiah, Calif., playing Daisy’s new cardiologist, decides he wants to see the 4D echo from the Salem Hospital. He logs into the HISP portal and requests Salem send the file. Again, Sharon easily attaches the file in MP4 format. It is under five megabytes, and Ross quickly downloads it and views it. Previously, that would have involved burning it onto a disk and sending it via courier. Or the cardiologist may have just ordered another test.

The demonstration also included how easy it was for the primary care provider to send the changes in Daisy Duck’s records to her own personal HealthVault account to share with her family members.

Cothren said that although this pilot was limited to three organizations, the model is easily scalable and WSC is engaging other stakeholders including the states of Alaska and Nevada. And the Office of the National Coordinator is working on a national trust framework that organizations such as WSC will soon pilot.

Although some people working in the health information exchange field have been critical of Direct as something of a distraction from more sophisticated and sustainable data sharing, I have to admit that seeing the elegant simplicity of this demonstration made me a believer. What about you?