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Four Ways to Exchange Data with Community Providers: Understand Your Specific Clinic’s Needs to Find the Right Alternative

Over the past several years, and with a push from the Centers for Medicare and Medicaid Services (CMS) meaningful use Electronic Health Record (EHR) incentives program, there has been an increase in adoption of EHRs. While use of an EHR by a clinic can provide more streamlined workflows, more legible documentation, and increased amounts of structured data, the “true value of adoption of EHRs comes when there is more liquidity and good data flow” said Dr. Ross Martin, Program Director, Integrated Care Network for CRISP (MD). He adds “This is why the HITECH Act was created.”

The Health Information Technology for Economic and Clinical Health Act (HITECH Act) was signed into law to “promote the adoption and meaningful use of health information technology” as well as addressing the ”privacy and security concerns associated with the electronic transmission of health information.” So, healthcare agencies, including local health departments, need to understand their best approach to the exchange of protected health information (PHI) between healthcare providers and agencies.

There are four basic options available:

1. Fax or electronic fax: The old fashion way. This is simply unstructured data, all paper-based, and a single point-to-point send and receive method. To help clinics, some EHR vendors will also install an electronic fax, as part of EHR, avoiding the need to print and fax. Users can simply click a button and send an electronic fax. The fax is not a structured data and thus cannot be easily integrated into a patient electronic chart.
2. Download CCD: Federal government has defined a good standard, termed CCR (Continuity of Care Record) and CCD (Continuity of Care Document), for exchange of patient data electronically. This is the standard which all federally certified EHRs must follow.  A CCD (Continuity of Care Document) document can be downloaded from EHR and given to a patient, say, on a USB stick. The patient can take this data to another clinic and the clinic can upload it into their EHR. Though this exists, it is not efficient and is a manually intensive process.
3. Direct Messaging: A patient record can be securely sent to another clinic via a secure Direct Messaging system. This is much like emailing a patient record but via a secure, healthcare-defined, messaging system. Direct messaging is really a way to exchange patient specific data with another federally certified EHR. This is a point to point system and replaces fax and now patient data is integrated, electronically, within a patient chart. This includes the structured data, all electronic, single point-to-point exchange. Though this costs a little bit extra, it may be the quickest and cost effective option to get going.
4. Health Information Exchange (HIE): This is the ultimate in exchanging data and HIEs are being rolled out, state by state, across the country. As we discussed in What is Health Information Exchange and Why is it Important for EHR use?, all EHRs connected to a HIE can share information via federally defined standards of CCR and CCD. Once a clinic connects to a local state HIE then data can be exchanged (electronically) with any other clinic connected to that HIE. This avoids having the need to do point to point data exchange via direct messaging. It has all the structured data, it is all electronic exchange, and best of all, has a multi-point to multi-point exchange capability. Roll out of various states’ HIEs are in different stages of maturity and connectivity. This method is the most useful if and when a large number of clinics are connected to the local HIE. Your EHR vendor will charge you to implement an interface to the HIE but this may be the best long term solution.

Which option shall you use? The main question to ask is, what data we wish to send and to whom (hospitals, community health centers, local health departments, primary care physicians). If a large number of clinics you wish to exchange data with are connected to local HIE then that is the best solution. However, if there is lack of connectivity to your local HIE, Direct Messaging may be the best and most efficient option for now.