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Contributing Writer · Oct 6, 2009

Interoperability and clinical chart sharing

The deliberations of the Office of the National Coordinator’s (ONC) are trying to build a platform where health data can be easily shared between appropriate stakeholders – physicians, patients, and others involved in healthcare – while maintaining privacy and security. The Federal Health Architecture (FHA) is an effort under the ONC that tries to set a platform where federal health IT is interoperable with private sector systems, and can therefore better serve point-of-service care. From a clinician’s standpoint, the ability to easily share clinical information – even entire charts – with other clinicians involved in the care of a given patient is a tremendous boon in the ability to deliver better-quality health care.

Clinical Chart Sharing – the ability to give to a clinician in a different practice the permission to view the chart of a patient being referred to them – is a big step in this direction. Just like with paper chart-sharing traditionally, patient permission is needed to allow the sharing of clinical information, and a foundation for such privacy and security is being developed within the ONC’s HIT Policy Committee. At this year’s Health 2.0 conference in San Francisco, Practice Fusion is unveiling its preliminary version of clinical chart sharing, signaling a significant step toward this goal.

But, is there any precedent for a “one-patient-one-chart” sharing of clinical information that we can use for reference? There certainly is, and it has been in place for decades: hospital inpatient charts have always been “one-patient-one-chart.” A patient’s chart in the hospital collects all the information about a patient’s course in one shared place – the chart notes from all the consultants involved in the case, everyone’s orders, x-ray and lab results, medications and diagnoses, and internal notes with the entire interdisciplinary team. Global permission granted on admission allows such chart sharing for the purposes of quality of care, and is protected from outside discovery by HIPAA and other confidentiality laws. Requests for hospital records from the outside are made via patient permission, and result in sharing of the records of all the clinicians involved to the outside requestor.

Clinical Chart Sharing extends this kind of experience to the ambulatory arena. A shared ambulatory chart, not unlike a shared hospital chart, is accessible by all the clinicians taking care of the patient – however, permission is granted one-practice-at-a-time, rather than the sort of blanket permission covered under the umbrella of confidentiality that exists within a hospital medical staff organization. But the experience of working with a shared document is something that is actually quite familiar with physicians – it is extending the inpatient recordkeeping experience to the ambulatory setting (where the majority of healthcare is delivered).

The ONC will continue to develop standards for interoperability, coming from the historic legacy of separate proprietary EHR databases which need to be connected via Health Information Exchanges (HIEs). However, web-based, hosted EHRs like Practice Fusion will build on their ability to bridge the gap between separate practices, and offer Clinical Chart Sharing now. And when the standards for interoperability emerge (recognizing that there may end up being a different set of standards for hospital and other high-end systems, and one for ambulatory systems that evolve out of market innovation), then such connectivity will be fairly easy to implement – there is only a single point of integration needed to connect all 20,000+ Practice Fusion users to whatever data-exchange emerges from this evolving process.

Robert Rowley, MD – Chief Medical Officer, Practice Fusion, Inc.