For most medical practices, a local hospital interface that allows patient information to be sent and received can be a great benefit when trying to proactively coordinate and manage patient care. In an effort to improve patient care and reduce health system costs, new care models such as Accountable Care Organizations (ACOs) and Patient Centered Medical Homes (PCMHs) are emerging. Increased attention is being paid to the importance of information exchange and using that information to coordinate care. Regardless of providers’ interest in these new care models, I have yet to talk to a primary care physician whose eyes do not light up at the prospect of timely access to information regarding recent hospitalizations, especially follow up instructions and medication lists. One of the most efficient ways for a medical practice to receive and integrate this information is via an interface with their EHR system. Surprisingly, many doctors I talk to do not see a hospital interface as an option, either because of the current dearth of communication or a lack of interest from the hospital in setting up an interface.
If you are excited at the prospect of getting this type of information, I encourage you to start exploring an interface with your local hospital(s). In advance of initiating this discussion, it is important to understand what types of data exist in hospital systems in order to determine the types of interface(s) that may be of value to your practice. What many providers may think of as a single interface with a hospital may actually represent multiple interfaces from the hospital’s perspective. Organizing data into categories may help you pitch the interface more effectively to the hospital, while also helping you decide how you want it integrated into your EHR system.
Below are descriptions of some of the most common types of data categories/interfaces:
- Laboratory: Setting up a hospital laboratory interface is similar to a regular lab interface. (Suggested reading: Four Things to Remember when Acquiring a Lab Interface.) Unfortunately, many hospital laboratory systems IT systems are highly customized or self-built. As a result, it may not be simple or low-cost for the hospital to build and maintain the interface.
- Radiology/Diagnostic Imaging:
- Results/Orders: The simplest form of radiology/imaging interface is the transmission of a written report. In some cases, radiology centers offer interfaces to order a study or investigation, but this is difficult for most hospitals due to the complexity of the orders and the number of departments that may be involved.
- Diagnostic Images: The interface used to exchange image files is referred to as a DICOM (Digital Imaging and Communications in Medicine) interface. DICOM must be combined with a PACS (Picture Archiving and Communications System) server at your practice to handle the image files. These files are large and can consume a lot of bandwidth and server space. Additionally, in order to view images at a high resolution level, you should consider the need for diagnostic quality monitors.
- Clinical Notes/Orders: It is important to recognize the difference between information you would like integrated into your ambulatory EHR system — for care that you provide in an office setting — and documenting or ordering care for patients you see in the hospital. An interface may be the best option in the first instance. If you are primarily looking for a ready source of hospital information, many hospitals provide portals through which you can look up patient information, which may be a more cost-effective option. If you intend to use your office EHR to document care being provided for hospital patients, you must ensure compliance with any legal/contractual obligations.
- Medication Lists: Understand which medication lists you would like to receive, e.g. inpatient medication lists or discharge medications.
- Discharge Summary/Continuity of Care Document CCD: Instead of a fully functioning interface, a hospital may be able to send a CCD document. This document generally includes useful clinical information including a patient care summary and medication list. Systems certified for Meaningful Use are meant to support this form of data exchange.
Many hospitals’ health IT solutions are assembled from components provided by different vendors. For example, the laboratory system and hospital EHR may be provided by completely different companies. As a result, separate interfaces may be needed in order to access information from all or some of these systems. Each interface may also be costly to develop and maintain.
An important point to keep in mind is the urgency with which you will need information via an interface. Do you need the information in real-time, in 2–3 hours, or in 24 hours? Depending on the structure of the interface and the source of the data, it can be complex and expensive to receive the results in real-time. Do you require status updates on orders? In general, the more information that is exchanged, the more complex and expensive the interface.
Also consider your practice responsibilities. How will you review and use the information? Do you have a strategy for reconciling information such as medication lists with your patients’ records? Work closely with your EHR vendor when integrating an interface and for specific training requirements. Remember that more information does not necessarily mean better information or better care.
If you are selecting an EHR, your hospital(s) may only support a small number of EHR vendors. If you are considering a STARK offering, this may influence your choice of EHR. Obtain a list of existing interfaces from potential EHR vendors. It will be much less complex and costly to implement an EHR that has existing interfaces with hospitals in which you provide care.
What have been your experiences with hospital interfaces? Add your comments below.
This post is the personal opinion of the author and does not necessarily reflect the official policy or position of the American College of Physicians (ACP). ACP does not endorse a specific EHR brand or product and ACP makes no representations, warranties, or assurances as to the accuracy or completeness of the information provided herein.