Information technology interoperability: How to get it right in LTPAC

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Robert C. Davis
Robert C. Davis
Providers have very important resident care, service and reimbursement issues facing them on an ongoing basis — all of which can be improved with appropriate information technology applications.

To enhance facility communications with other providers and vendors while improving patient care, one of the most important things to consider is interoperability. There are varying degrees of sophistication for both vendors and providers. If the right level isn't reached, caregiving and facility efficiency could suffer.

Summarized here is a list of functions and capabilities to be considered in evaluating and discussing interoperability.

First, for a vendor system to be capable of interoperability, it must possess at a minimum the following:

• The data elements in the standardized format to be shared. Many vendors have only free text content so it is impossible for them to share data in the desired format. For each type of interface, the data elements are different. A few examples are:

   1. Patient demographic information, billing status and specific Medicare/insurance coverage information in HL-7 message format.

   2. Lab orders and results must eventually conform to the SNOMED and LOINC standards.

   3. Lab results must be connected to the original order and patient, and be in an agreed upon format for automatic placement in the electronic health record.

   4. Medication orders must contain the correct elements for the pharmacy to fully understand and interpret the order correctly. Elements that must exist in a common and standardized format are:

      §  Drug name, strength, form, NDC number and full physician instructions and times of administration

      §  Additional items include special instructions such as duration and methods of administration

      §  Patient allergies and other possible medication conflicts or restrictions

      §  Messages must be bi-directional to provide timely and accurate order status information to the provider.

• Transfer documents should be in a CCD (continuity of care document) format. This is very important since better patient transitions are a primary goal of all healthcare stakeholders.

Other important considerations for providers are:

• One-direction messages or faxes of an order is not interoperability and should not be represented as such. Many vendors represent that they have interoperability based on faxes.

• Pharmacy interfaces are very complex and there are several pharmacy software systems used widely in LTPAC (long-term and post-acute care). Providers must confirm independently the existence of the desired pharmacy interface and its full functionality.

• Sharing of information with regional health information organizations (RHIOs) and health information exchanges (HIEs) will become more important in the future, and interoperability is required for this activity.

Included in the Certification Commission for Health Information Technology (CCHIT) certification requirements are many of the elements described above. Therefore, a provider should inquire with its vendor or prospective vendor on its plans for certification and the ability to meet the certification standards. A certified vendor will be able to perform interoperability.

Conversely, a vendor that does not plan to be certified or hedges on the timing of certification should be excluded from consideration.

Robert C. Davis is Chief Executive Officer of Optimus EMR Inc.

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