Published on Thursday July 11, 2019
Eagle Physicians and Associates has always been committed to obtaining complete patient information to guide medical decision-making. With the rise of nationwide interoperability networks, Dr. Robert Fried has taken a leading role in helping shape systems that can ensure maximum visibility of each patient’s record. Today’s interoperability solutions are meeting that goal in ways that cost less — in time and money — than the point-to-point interfaces of old.
“We hammered out, at least for an outpatient encounter, and a hospital encounter — those two different documents, what we think needs to be in those, so there’s now this standard that’s going to be propagated to the EMR vendors, saying this is how you should implement your CCDs that get sent across the Carequality framework.”
Dr. Robert Fried, Chief Medical Information Officer, Eagle Physicians and Associates
Sequoia Project’s Carequality Framework offers providers a common legal framework and technical specifications for exchange of clinical data. eClinicalWorks partners with Surescripts’ National Record Locator Service to make data available through our Interoperability Hub, improving patient safety and helping clinicians at the point of care. Carequality is available through On-Demand Activation.
eClinicalWorks is a contributing member of the CommonWell Health Alliance, dedicated to permitting members to exchange clinical data. CommonWell members enjoy query-based exchange of clinical data, which is imported into the Interactive Clinical Wizard within the eClinicalWorks EHR, with no need for regional or state health information repositories.
The eClinicalWorks Electronic Health eXchange (eEHX®) is a comprehensive Health Information Exchanges (HIE) solution that facilitates interoperability between clinical systems in community-wide settings. eEHX is a vendor-neutral solution that gives providers real-time access to a patient’s longitudinal health record at the point of care, enhancing clinical decision support, and improving care coordination.
Adam Siladi: In today’s healthcare environment, more information than ever is being captured by clinicians in their Electronic Health Records. But that data is often segmented, and sharing that information is still a challenge. Fortunately, recent enhancements in the realm of interoperability are working to change that. And here to speak with me about his practice is using interoperability to the benefit of his practice and his patient is Dr. Robert Fried, Chief Medical Information Officer at Eagle Physicians and Associates in Greensboro, North Carolina. Dr. Fried, thank you so much for your time.
Dr. Fried: Thank you for having me.
Siladi: Dr. Fried, tell us a little bit about Eagle Physicians and how interoperability has changed for you in the last few years.
Dr. Fried: Well, interoperability, first of all, I mean defined, is the capability of sharing data between disparate programs. So, you’ll often hear me talking about trying to get data out of the Epic program at the hospital and, you know, obviously they can fax those things, we can call and ask for the latest stuff, we can even log on to their system for some users. That’s not interoperability. Interoperability is when they send us something electronic, which then, eClinicalWorks can read. So, we’ve long recognized the need. Our patients, they go to the emergency room, are going to go through a Cone Health facility, or one of the medical centers — Wake Forest, UNC Duke — and if the ER doesn’t have their medication list, or their problem list, or whatever, we consider that a big deal. We actually had one patient, more than one patient, was told by the ER doctor, “You should get a doctor who is on Epic, so I can see your information.” So, that got us to saying “How do we fix this problem?” So, we became one of 10 pilot sites with eCW who developed an eCW-to-Epic interface. And that was developed during, you know, the 2015-16 timeframe, and, just after that came online, we were pleased to see that Carequality came online. So, in the interface world, you have to develop a new connection to each hospital system, and each outside provider that you might want to get information shared with, and in the Carequality world, you connect to one framework, or really if you look at CommonWell is the second framework, so maybe you connect to both. eClinicalWorks had the vision to connect to both, so as an eClinicalWorks customer, you can be connected to both, and then you can see information on your patients from any other organization connected to one of those two frameworks, and it’s been really useful.
Siladi: Absolutely. You know, taking that burden off of practices of trying to build those point-to-point connections to all of the places they may need data, just sounds like a big challenge. So, like you said, fortunately eClinicalWorks partners with both CommonWell and Carequality, and we offer those integrations at no charge to clients. So they can connect to these networks and they can hopefully get access to that data for their patients, wherever they’re being seen. So, Dr. Fried, what types of information are you receiving through interoperability, and how are you putting it to use?
Dr. Fried: So, there’s a number of kinds of documents that come across. Primarily, there’s three of them. One is a patient summary, and these are called CCDs, clinical care documents. They are — which is just a format, sort of like a PDF is the format of a document. And that has things like the patient demographics, and their social history, and their family history, and their, you know, things that don’t change with every visit. And then there’s a visit-level summary, which may be a summary of a hospital encounter, or an outpatient encounter. May have the Progress Note in it, which is great when it’s got it. Often it will have the vital signs, you’ll have the patient’s medication list, and discharge instructions, things of that sort. And then there’s a thing that comes from the Surescripts National Records Locater Service that sort of tells us what other practitioners the patient’s been to, with a series of dates. So each of these is useful in a different way, but the last one I mentioned, sometimes it’s helped me need to know that the patient saw a specialist I didn’t know they had seen, and they didn’t tell me. They saw a neurologist for a dementia evaluation but forgot to tell me. And it gives me the contact information to get in touch with that neurologist. The biggest one, the most useful one, are these visit summaries. So, they’ll have lab results, and that, my, one of my favorite ones was a diabetic who came in. I’m seeing her, it’s like 5:00 p.m., she was the last one on my schedule, and I said “What labs did your weight loss surgeon do?” She said “I just had all these labs a month ago, you probably don’t need to do anything.” And they hadn’t sent me anything, they were in a totally different town, different system, and I went into the Carequality and picked up her document, and it showed me that she’d had the comprehensive metabolic I needed, she even had the lipid panel I wanted, did not have an A1c. So I figured out that she needed an A1c and she didn’t need the other stuff because I had the results if you have it just a month ago. So, to me that’s a great example of where having the information for those saves on duplication of care.
Siladi: Absolutely, and in today’s environment where we’re trying to improve outcomes while reducing costs, you know, not running those tests over and over again, I’m sure, not only reduces those costs, but also saves you time when you’re trying to provide the right care for those patients. What are some of the other scenarios where you’ve used data from interoperability to support patient care?
Dr. Fried: Well, I’ve had a patient come to me at an urgent care site that we have, who said “Well, I’ve seen an orthopedist a couple times for a workman’s comp problem, and he said my blood pressure’s high and I need to see somebody about treating my blood pressure.” Well, if you know the guidelines on treating blood pressure, if it’s just moderately high, you don’t pull out medicines the very first time. You’re supposed to see it elevated on three separate occasions. So I went in and I could see the orthopedist’s notes and Carequality, again, a different EMR, a different company, different system, and we were, I think we were on a Saturday morning at the time I was doing this, and so I couldn’t have even called them, but I could see the visits, each of the visits that they’d had, and the vital signs, and I could confirm that they’d had persistently elevated blood pressure and get the patient started on treatment right then and there.
Siladi: Definitely sounds important, again not delaying that care that patients need, having that visibility to that information from those other systems. It sounds like it’s making a big, big impact there. Now most practices, I think, are very concerned with trying to obtain information from other sources, as you’ve mentioned, that’s pretty critical when you’re trying to provide care for patients, knowing what’s happening in those other systems, especially when people might not be sending it to you reliably, or you might not even know that they had gotten care in those other settings. But do you see interoperability as a two-way street?
Dr. Fried: Definitely. The problem we’ve had where a patient shows up at the emergency room and they don’t have a record in Epic and the ER doctor needs to know the medications and problems and all of that, has been solved with Carequality. We know that the Epic users can go into a portion of their program called “Care Anywhere” and look at Eagle records and see the visits that happen at Eagle and see the med list. They can import medicines, if they want, from our list to theirs. So, it’s definitely a two-way street. I think it’s beyond that. It’s a network, you know, there are many different organizations that get to see this data. I’d like to make the distinction though, is that this isn’t moving the data into eClinicalWorks. It’s making outside data available from within eClinicalWorks. You have to take the specific action to import one of these documents that you see. You can put it in your patient documents, but there’s almost no need, you know, you just, you can see it, but it’s stored on the cloud somewhere. Or, in many cases, it’s just generated on demand from the outside organization.
Siladi: Definitely an important distinction. And for those of you who don’t know, when you are connected to these networks, CommonWell and Carequality, if your patient is marked as arrived in your practice, those networks, the system knows to query those networks for new records to see whether any information is available for you to use in your visit, as Dr. Fried had just mentioned. Now, Dr. Fried, I understand that you were part of the document content workgroup. What was that group and what role did it play in enhancing the functionality of interoperability?
Dr. Fried: So, there’s an organization called The Sequoia Project. They are the supervisory organization for Carequality and some other interoperability initiative. And they convene this workgroup, which was for the purpose of trying to figure out what should be in the documents. What’s the content that needs to go? So, I like to say that we’ve sort of laid the pipes for the water to flow, and now we’re talking about what’s the quality of the water in those pipes, and that’s what the content document workgroup was doing. And we came — I was pleased that eCW sort of nominated me to be on there. There was also a technician from eCW, there were doctors using Epic, and a technician, and there were one or two Epic experts, Cerner, others, through many different people who know a lot more than I do about the technical details of these document specifications. But we hammered out, at least for an outpatient encounter, and a hospital encounter — those two different documents, what we think needs to be in those, so there’s now this standard that’s going to be propagated to the EMR vendors, saying this is how you should implement your CCDs that get sent across the Carequality framework.
Siladi: Well, I’m sure that everybody who’s using those CCDs is very grateful for the collaborative efforts that you and the document content workgroup have put into interoperability. For clients who do not have access to CommonWell or Carequality right now, as we said before, eClinicalWorks makes those integrations available at no extra cost for clients, and turning them on is as easy as an On-Demand Activation. So you could go, right after this podcast, go into your admin area into product activation, and turn on your connections to CommonWell and Carequality. Of course, if you’d like more information about these tools, you can find that on my.eclinicalworks.com, or you can speak with your Strategic Account Manager. Dr. Fried, I wanted to say thank you again for your time today, answering our questions about how you’re using interoperability, and hopefully our viewers will put some of those things into place in their practices. If you’d like to check out our other episodes of the eClinicalWorks Podcast, you can check them out on iTunes, YouTube, or my.eclinicalworks.com. For the eClinicalWorks Podcast, I’m Adam Siladi, and thanks for watching.