Electronic transmission: not so simple

July 9, 2014 in Medical Technology

On paper, it sounds easy. Eligible hospitals that refer patients to another care setting must electronically transmit “a summary of care record for more than 10 percent of such transitions and referrals.”

[See also: For portals, speak patients' language]

The twelfth of Stage 2 meaningful use’s 16 core measures requires that such a summary of care be either transmitted to another recipient using certified electronic health record technology, or with help from an organization that’s either an “NwHIN Exchange participant or (operates in) a manner that is consistent with the governance mechanism ONC establishes for the nationwide health information network.”

Turns out that’s easier said than done.

[See also: Direct Project: A new way to transfer data]

A common theme emerging as hospitals work toward Stage 2 is that the hardest measures are those that depend on cooperation or connection with outside parties: whether it’s the 5 percent threshold for patients to view, download or transmit their health data, or the 10 percent threshold for electronic transmission of care summaries.

In June, we showed how New York Hospital Queens, by making a “full-court press” on patient access, is well-positioned to achieve the former measure. But the latter requirement is still posing a formidable challenge, says Kenneth Ong, MD, the hospital’s chief medical informatics officer.

That 10 percent hurdle is hard to clear for a variety of reasons, says Ong. Among them: the majority of other practices his hospital deals with don’t have EHRs enabled with HL7′s Clinical Document Architecture standard; some regional health information organizations still don’t support Direct messaging inboxes or CDA exchange via the NwHIN protocol; many receiving providers don’t have Direct inboxes and are unwilling or unable to pay for them.

“The summary of care measure? It’s been a challenge for us, as well as others,” said Ong. “One problem is actually getting the technology to work.”

Direct messaging has been a particular problem. “We’ve been working on that with our vendor now – who I will not name – for more than two months,” said Ong when we spoke in late June. “Despite adding a number of hotfixes, they still have not been able to get it to work.”

His colleagues at other hospitals across the country are facing similar issues, he said. “One person told me it took them six months to get it to work. And someone else told me it took them two years.”

It seems surprising that such a core functionality would be so hard to make work. But Ong suspects that compacted calendars are somewhat to blame.

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