Understanding HIE Workflows
EHR applications have become the center of clinical workflow evaluation and change for many physicians both in the ambulatory physician practice and the inpatient environment. However, the evolving Meaningful Use regulations in Stage 2 and overall competitive pressures have placed a greater priority on the ability to exchange clinical data between disparate systems and independent care providers. The primary vehicle for this exchange of data is through some form of Health Information Exchange (HIE).
HIE solutions are intended to quickly and easily supply healthcare providers with additional information on a patient. Yet, many HIE’s continue to struggle to reach critical adoption levels due to challenges in ease of accessing or utilizing data within the network. HIE solutions with smooth clinical workflows allow users to operate within their existing environments without additional applications or portals requiring a sign-on. Applications that require physicians to break their clinical workflows risk lagging adoption rates.
“The doctors were interested in this to start out, but once they realized that they were going to have to do things in two different places, they lost interest. It is just too cumbersome.” (HIMSS 2012 Presentation, Jason Hess, KLAS)
“Some of our physicians won’t use the HIE if they have to search for the data in a portal. HITECH funding is great but it has ground some of our decisions to a halt.” (HIMSS 2012 Presentation, Jason Hess, KLAS)
The ability to identify and evaluate the critical clinical workflows in an HIE environment will provide a number of benefits for a set of healthcare trading partners. These benefits include:
- More efficient and successful deployment of HIE solutions
- Drive towards usage levels required for Meaningful Use
- The establishment of “benchmarks” and key metrics to set expectations on both workflows and return on HIE investment
- The ongoing evaluation of clinical outcome enhancements through HIE in areas like medication errors, transitions of care and preventable readmissions
Following are a set of specific HIE workflow examples common within healthcare environments.
Retrieving clinical information on new patients
Emergency departments account for a large percentage of the new patients received at healthcare organizations, which highlights their need for historical clinical data. Many patients in life threatening situations are unable to communicate information about past care or existing health records. In that case, medical records staff can spend an hour or more contacting nearby health systems for essential information. Integrating HIE solutions with ED workflows provide access to shared community records while retrieving clinical information on new patients.
Prescribing addictive medications
Addictive medications can present a challenge to emergency departments when treating a patient without an existing medical record. Providers often contact other nearby healthcare organizations or emergency rooms to check for recent similar prescriptions to the patient in an effort to prevent abuse by drug seekers.
Referrals and Transitions of Care
Physician referring patient to specialist
Physician referrals are usually just a call away, yet increasing time constraints are making it harder for providers to make calls and decreasing the likelihood of reaching the desired specialist or their staff. The most onerous aspect of referring a patient to a specialist is often sharing relevant clinical information whether that is background information for the specialist or a follow up note to the physician from the specialist. Physicians, specialists, and their clinical records staffs all benefit from improved workflows associated with the secure messaging options as part of an overall HIE solution.
Hospital referring patient to specialist or LTC
Transitions in care represent a number of challenges in terms of communication and information sharing between the organizations involved. For a hospital, this can often lead to time spent printing and shipping records, using a secure fax line to send records or making phone calls.
Physician referring patient to hospital
Referring a patient to a hospital within an integrated delivery network can be a very smooth process, yet referrals between locations with different software solutions and referrals from affiliated or independent physicians continue to present a number of workflow challenges. Access to electronic referral solutions offer workflow improvements for physicians and support staff while setting up the referral, while sharing information on the patient and with post-referral communications.