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Pandemic underscores need for national Interoperability


Physicians and other providers need access to records now. Here’s one way they can.

coronavirus, COVID-19, EHR, interoperability

The COVID-19 pandemic has shown the weak spots in the U.S. healthcare system. Besides the severe shortages of testing, gloves, gowns, masks, hospital beds and ventilators, it’s also revealed shortcomings in interoperability among providers.

The U.S. Department of Health and Human Services (HHS) released two rules in early March designed to make provider and patient access to data easier. The provider information sharing rule, set to go into motion on September 1, 2020, requires electronic notification of care transitions and makes information blocking illegal. This rule is a huge leap toward interoperability, but it’s not in place now when the right information about a patient can mean the difference between life and death. Providers on the front lines of the outbreak and the COVID-19 positive patients they treat can’t wait for the eventuality of interoperable records. They need access now.

In the U.S., the Carequality Network has set the standard for access to patient records, pooling together patient information stored in the largest EHR systems – both acute and ambulatory – in the nation. There are more than 600,000 providers in health systems and clinics on the network. In the crisis we’re currently facing, they recently released a policy statement temporarily relaxing some restrictions for access. This has enabled smaller EMR systems to access the network, and even cleared the way to allow access for providers with no EMR at all to get this vital information. 

One such system which includes access to the Carequality Network is Consensus from J2 Global, a worldwide leader in cloud security and communications. With providers and their staff already stretched thin while battling this pandemic, there are limited staff available to respond to the often burdensome and error prone process of handling record requests, putting both patients and providers at risk. Now, providers can register to access patient records through the Consensus platform during the current state of emergency and for a time of transition afterward at no charge.

Those over 65 and people with high-risk conditions such as lung disease or asthma, serious heart conditions and those who are immunocompromised are particularly vulnerable – and they are more likely to have complex medical histories the patient themselves or their caregivers may not

have fully documented. While particularly essential during this historic pandemic, access to medical history data is central to optimizing care delivery in every encounter.

Regardless of whether the country is in the midst of a historic pandemic or whether someone is visiting a new provider, the more information medical providers have, the better care decisions they can make.

Initial steps toward interoperability

The stress on front-line healthcare workers to quickly assess a patient’s acuity level and history and prioritize patients at greater risk has increased dramatically with COVID-19. Emergency rooms, urgent care centers, specialty providers, telehealth providers, skilled nursing facilities (SNFs), durable medical equipment (DME) companies and others across the care continuum are all struggling with access to needed patient data.

Shortcomings in communications were apparent long before the pandemic hit. Although electronic medical records (EMR) systems have been around for years, data from other systems within a healthcare facility or system often doesn’t flow into the EMR. And when a patient moves from provider to provider, that information rarely moves with the patient, except for physical documents and CDs of images.

Earlier attempts at interoperability have been piecemeal. Connecting a hospital’s EMR to its ambulatory physician EMRs, along with imaging, labs, admission, discharge, and transfer (ADT) system, pharmacy and more requires specific connections between each system and the treating provider’s core EMR. Bringing data to a common platform for several hospitals or a regional health system multiplies the number of required connections exponentially.

Providers in a geographic area can also share information through health information exchanges (HIEs), but adoption varies widely among regions. An HIE can help providers track patients as they move from physician to physician, imaging center to hospital, hospital to nursing home, and to other providers that may not be otherwise affiliated.

Direct secure messaging has made significant progress in helping providers increase interoperability. At the end of last year, direct had nearly 200 million messages on its healthcare network. While this communication method works well if you know the address – like an email address – of the recipient and you have a specific workflow like a referral, prescription, discharge information or other care transitions, it falls short of finding information within a larger framework across an entire community of data.

Outbreak shows the importance of interoperability

Interoperability is also critical for reporting outbreak data to public health agencies and the Centers for Disease Control and Prevention to guide containment efforts. COVID-19 has cast a bright light on the need for standards and a constant funding source to make reporting faster and easier. While Congress has appropriated billions for a novel coronavirus response, similar funding for such outbreaks as Ebola and severe acute respiratory syndrome (SARS) did not translate into new electronic reporting standards.

The same interoperability would allow researchers to easily collect data that could be used to identify trends in symptoms, mortality rates, treatment modalities, recovery times and more across hospitals or geographies. At the same time, information could be pushed to providers to hone screening methodologies as understanding evolves about the outbreak, where it’s concentrated and the vulnerable populations at risk.

Telehealth visits, which are becoming increasingly common during the pandemic, can be more meaningful if the remote provider can pull relevant patient records before a visit.

How Consensus can help

When seeking emergency care or care in a new clinical setting, a common procedure would be to request records from a previous provider. In fact, many states are requiring that as part of an ED visit. As healthcare assumes an all-hands-on-deck mentality amid the outbreak, fewer office employees who handle patient records are available to handle requests or, in some cases, those offices are closed.

On-demand patient record queries through Consensus can help ensure timely and coordinated care responses by providing no charge access to records from a community of providers. Although emergency departments and urgent care clinics are most likely to benefit, any provider that needs patient records from other providers will quickly see the advantages.

By simply using the Consensus platform and keying in patient demographics, including their address or phone number, you can receive comprehensive patient records from a community of providers, choose the records you would like review and save and either print, download or forward into your EHR.

At its core, on-demand patient record queries allow pertinent patient information to flow from one provider to another to give doctors and medical staff sufficient and relevant data to enhance the medical decision-making process. COVID-19 makes that more difficult because the fragmented nature of the current patient record.

As the COVID-19 pandemic continues to push our healthcare system to the brink and forever change the model in which healthcare services are delivered, cracks are abundantly apparent in the current interoperability landscape. However, recent legislation and industry efforts are turning the tide toward interoperability. Once the current outbreak ebbs, however, the healthcare industry should come together to tackle the interoperability challenge once and for all. The result will be more-coordinated care, better overall care and quicker reporting of public health issues.

John Nebergall is senior vice president and general manager at J2 Global Cloud Fax.

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