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Data mapping helps bridge the interoperability gap

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ANN ARBOR, MI, September 16, 2013 – San-Diego-based Sharp HealthCare, one of the nation’s leaders in implementing electronic health records, also devotes significant resources to ensure that patient information is easily accessible and patients are correctly identified within its records system to support its 2.3 million visits per year.

Sharp’s efforts to ensure the integrity of its digital records are highlighted in the most recent case study released by the College of Healthcare Information Management Executives (CHIME).

The integrated health care delivery system is in the midst of constant change, as are most healthcare organizations across the country. The implementation of new clinical information systems brings challenges in linking them to one another within an organization. Beyond that, pressures of healthcare reform are prompting organizations to form relationships with other providers – in ambulatory or post-acute care settings – that typically run different information systems and have less IT prowess. And area provider organizations that have competed for years are trying to put aside differences to work on large-scale healthcare information exchange (HIE) projects.

Sharp’s situation is one that is typical, faced by providers nationwide. The pressure is growing for providers to move to electronic health records (EHRs) and increasingly be able to share data with other organizations, said Bill Spooner, senior vice president and CIO at Sharp.

“In an era of frequent mergers, innovative provider affiliations, collaborative care arrangements and declining revenues, it is essential to view our patients across that entire care continuum,” Spooner said. “Robust interoperability is a competitive advantage deserving greater appreciation.”

At Sharp, its seven hospitals use one electronic records system, while physicians at its medical groups use another. Sharp then uses a separate application to create a virtual patient record in which data is brought together and aggregated from a variety of sources.

Data is “mapped” from the hospital and medical group applications, a labor-intensive process that requires review by IT staff with clinical backgrounds, said Elizabeth Renfree, director of interoperability for Sharp. “To have a medication appear as ‘like for like,’ you have to do a fair amount of translation between the two systems,” Renfree said. The mapping enables grouping and harmonizing of patients’ medical records, so that clinicians have an easier time looking at trends and don’t have to piece together record components.

Vendor applications are starting to use standardized languages to simplify descriptions within patient records. For example, medical terminology is moving toward the use of SNOMED Clinical Terms; differences in drug descriptions can be resolved through the use of RxNorm, which provides normalized names for clinical drugs and links its names to many of the drug vocabularies commonly used in pharmacy management. Still, differences in terminology usage exist between vendors’ systems, and Sharp gets around these by mapping to standard medical terminologies into its own corporate health information exchange.

Finally, the use of EHRs ups the ante for making sure that there are no mistakes in matching patients with records. Record duplication gets a lot of careful attention at Sharp, which operates a master patient index department to sort through identity issues. The staff of 10 regularly looks into questions about patient identities to ensure there’s only one set of medical records per patient. As Sharp continues work to participate in an HIE for the San Diego area, it acknowledges that issues involving patient identity and privacy are particularly challenging.

"Making Information Flow: Even with EHRs, There’s More Than Meets the Eye" is the fifth in a series of case studies by CHIME, an Ann Arbor, Mich.-based professional organization, which highlights the benefits and best practices of successful implementations of information technology. To access the full case study, visit: http://www.cio-chime.org/chime/press/CaseStudy/Sharp_Case_Study.pdf


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