HIMSS FY18 I&HIE Toolkit Work Group HIMSS2018 Interoperabili

HIMSS FY18 I&HIE Toolkit Work Group HIMSS2018himss Interoperabili

The Oregon Clinic, an independent specialty physician organization in the Pacific Northwest, faced significant interoperability challenges due to the use of multiple EHR systems across their practices and hospital affiliations. Their goal was to improve data exchange with local hospitals and other healthcare entities, transitioning from manual, time-consuming methods like faxing to automated, electronic bi-directional communication using standards such as C-CDA, HL7, and IHE profiles.

Initially, The Oregon Clinic participated in Meaningful Use stages but realized compliance alone did not guarantee interoperability. Under leadership from their CEO, Dr. Craig Fausel, and with support from key partners like Providence, Legacy Health, Epic, and GE Healthcare, they launched a pilot project to establish secure, standards-based communication channels. They focused on three primary goals: processing referrals via Direct Messaging with C-CDA documents, enabling real-time bi-directional exchange with hospital systems, and exploring asynchronous provider-to-provider communication.

Their efforts involved developing technical infrastructure such as SSL connections, IHE profiles, and federated networks to facilitate document sharing. Challenges included ensuring data was accessible within clinicians' workflows, managing differing provider priorities, and changing established clinical workflows. Engagement with physicians was critical, involving iterative feedback and workflow adjustments to improve usability and clinical relevance. For example, clinicians could preview incoming C-CDA documents and select relevant sections for import into their workflows, enhancing usability and acceptance.

The referral processing workflow was streamlined so that external PCPs could send referrals via C-CDA, receive confirmation of receipt, and obtain consult notes electronically. This eliminated manual steps and reduced delays, increasing efficiency and accuracy. The bi-directional exchange with hospital systems involved collaboration with GE and Epic to leverage their CareEverywhere and Carequality platforms, enabling clinicians to query and retrieve clinical documents seamlessly. Integration of Cross-Gateway Access (XCA) profiles facilitated sharing across different communities, further expanding access to patient records.

The third goal, asynchronous provider communication, remained a work in progress, with the organization exploring various solutions to facilitate real-time advice exchanges, such as consultation requests or test ordering guidance. Success measurement relied heavily on provider feedback, message volume growth (from 4,000 to over 12,000 messages per month since joining Carequality), system performance monitoring, and ongoing stakeholder engagement.

Implementing interoperability significantly impacted workflow but faced resistance. Resistance stemmed from clinicians' reluctance to adopt new workflows and initial rejection of complex C-CDA referral documents. The organization addressed this through clinician training, customizing document content to meet clinical needs, and highlighting tangible benefits like reduced manual work and faster information access. Over time, trust and confidence increased, fostering broader adoption.

Budget and costs were primarily staff-driven, with resources allocated over 18 months for development, testing, and implementation. Major challenges included the lack of existing structural roadmaps, the need for motivated partners, and managing change within clinical workflows. These hurdles underscored the importance of strong leadership, strategic partner selection, and ongoing stakeholder communication.

Lessons learned emphasized listening to clinicians, leveraging physician champions, developing strong community partnerships, and enhancing knowledge about technical standards. The Oregon Clinic’s efforts resulted in exceeding initial goals: over 90% of referrals now processed electronically, and thousands of clinical documents exchanged monthly. Their experience underscores that interoperability is a continuous journey requiring strategic planning, stakeholder engagement, and adaptable workflows.

Paper For Above instruction

Interoperability in healthcare has been a longstanding challenge, largely because of the fragmented nature of health information systems and variable standards adoption. The Oregon Clinic’s journey exemplifies how a focused, standards-based approach can transform clinical workflows and enhance patient care. This case study underscores both the technical and organizational facets required to achieve effective interoperability.

The initial state of The Oregon Clinic’s data exchange was heavily reliant on manual processes. Faxing referrals and manually entering data into EHRs introduced delays, potential errors, and inefficiencies that impeded timely and accurate clinical decision-making. The clinic recognized that manual exchange methods could not meet the demands of modern healthcare delivery and sought to adopt structured, electronic data sharing mechanisms aligned with national standards like C-CDA, HL7, and IHE profiles.

The organization’s leadership was pivotal in setting a strategic vision for interoperability. Driven by the desire to improve clinical workflows and patient outcomes, they prioritized three main goals: implementing referral processing via Direct Messaging, establishing bi-directional exchange with hospital systems, and exploring asynchronous communication methods. These goals aligned with broader industry objectives and were achieved through incremental yet coordinated efforts.

Developing the technical infrastructure required understanding and applying standards such as IHE profiles and SSL encryption to ensure secure, reliable data exchange. Collaboration with vendors like GE Healthcare, Qvera, and Epic was fundamental. The team built federated networks and utilized platforms like CareEverywhere and Carequality, which facilitate cross-community access to clinical data. These efforts enabled clinicians to retrieve relevant patient information quickly, thus integrating shared data into their workflows.

Engaging clinicians was essential for success. The Oregon Clinic adopted a participatory approach, using iterative feedback to refine workflows and document presentation. For instance, clinicians preferred to preview incoming C-CDA documents and selectively import only relevant sections, balancing information richness with usability. This incremental approach fostered trust and led to increased adoption, demonstrating that technological solutions must be aligned with clinical needs.

Implementing the referral process through C-CDA and Direct Messaging allowed for a closed-loop system where referrals, encounter documentation, and consult notes flowed seamlessly between PCPs and specialists. Automating these tasks reduced manual efforts, improved accuracy, and expedited patient care. Similarly, integration with hospital systems enabled real-time exchange of clinical documents, improving continuity of care and reducing redundant testing.

The adoption of CareQuality membership expanded data sharing beyond local partners, connecting The Oregon Clinic to a nationwide network of clinical records. This increased access facilitated comprehensive patient views and supported more informed decision-making. The exchange of over 90% of referrals electronically and thousands of documents monthly reflects significant progress towards interoperability goals.

Despite these successes, challenges persisted. Resistance to workflow changes, initial complexity of documents, and the need for ongoing stakeholder engagement required persistent effort. Change management strategies, including physician champions and tailored training, proved crucial. Learning from initial setbacks, the clinic adapted workflows and strengthened relationships with community partners, leading to broader buy-in.

The experience at The Oregon Clinic underscores the importance of leadership, stakeholder engagement, standards-based architecture, and flexible workflows in achieving interoperability. Their journey demonstrates that, although technical standards lay the groundwork, organizational culture and change management are equally vital. As healthcare continues to evolve, such case studies offer valuable insights into practical strategies for fostering interoperability that is sustainable, scalable, and aligned with clinical realities.

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