Integrating separate and complex clinical information systems in a large health authority is like working with a giant Rubik’s cube – but it can be done. Fraser Health, which has 23,000 staff servicing 1.7 million people in the Greater Vancouver area, is successfully implementing a commercial off-the-shelf health information exchange (HIE) solution to unify clinical information from hospital, community health, primary health care and provincial systems.
But now that the HIE solution is in place, the work to link all the systems is far from done. “Health information exchange is a continuous journey,” explains Philip Barker, VP of informatics and analytics at Fraser Health.
From the starting point in 2012, the goal of the Unifying Clinical Information project was to implement a HIE that would allow Fraser Health to exchange information between all its clinical systems, says Barker. “We wanted all relevant information to be available to support clinical decision-making at the point of care, with no additional sign-ons or patient searches, while also minimizing clicking and keying to get that information.”
To accomplish this, Fraser Health selected Allscripts’ dbMotion, a HIE solution, to interconnect its Meditech systems running in 12 major hospitals, Civica Paris in community health, Intrahealth EMRs in primary care, and various provincial systems.
“We wanted an interoperable, integrated solution as opposed to overlaying a clinical system on top of other clinical systems. The difference is that it changes how you use a clinical information system. dbMotion makes your home clinical system very intelligent because it presents information in context, in the moment, from all other clinical sources. You don’t have to drill down or hunt for information.”
dbMotion’s HIE technology also offers some highly useful intelligence features, adds Barker. “It does semantic harmonization across systems, which means it recognizes similar medical terms. For example, if a patient has ‘peanut allergy’ in one system and ‘walnut allergy’ in another, and presents them in a meaningful way. We thought this feature was particularly unique.”
Another critical feature is the ability to place an agent on clinicians’ desktop to notify them when new clinical information on that patient is available. “It’s a tab that floats across the desktop to attract attention when there’s relevant new information they haven’t seen yet.”
dbMotion also offers a feature that enables Fraser Health’s HIE to share data with other health authorities. “It puts it in a clinical data repository that then can be used to exchange information with other health authorities or provincial e-Health projects. It’s very important for us to be able to exchange our information, as the boundary between Fraser Health, and say, the Vancouver Coastal Health is porous and patients move between them.”
The HIE was implemented in 2013, and the project team has begun the long journey to interconnect various systems to create a unified healthcare ecosystem.
At the core of the HIE is establishing a patient’s identity with certainty, as this is needed to identify and track all the patient records flowing from one system into another, says Barker. “We worked closely with the Ministry of Health to leverage its client registry – the provincial electronic master patient index – so we could use it to identify and adjudicate client identity between our systems. The challenge of patient identity is very significant and you need to have eyes wide open to ensure your data is clean and there are good identity mechanisms in place.”
Using the provincial registry’s ironclad identity mechanisms minimizes the repetitive sign-ons and drudgery that can frustrate HIE users, he adds. “The registry ensures it’s the right patient. That minimizes clicking and data entry because you don’t have to hunt for patients or pick them from a list.”
One interconnection of the Unifying Clinical Information project has been completed thus far. “We’ve implemented the dbMotion solution to the point where the Paris system, which is our community health service delivery system for mental health, substance abuse and home care, can view information from our hospitals’ Meditech systems.”
The team is currently working on the reverse flow – to make Paris data available to Meditech systems – and also integration with the provincial lab information system (PLIS) to make public and private sector lab results available to all Paris and Meditech users simultaneously. “This is all scheduled to go live in June 2015.”
Decisions about the sequence of systems to link-up and roll-out are made by a clinical working group. “We have plans to integrate the next large clinical system, which is Intrahealth, used by our primary care providers,” said Barker. “And we’re going to be integrating our HIE with other provincial repositories such as Pharmanet, which will make pharmaceutical information much more readily available to our clinicians.”