4 ms·

I think that is the critical point: there is no interface between hospitals. What little infrastructure the HITECH act sketched out on this point was vague and

I think that is the critical point: there is no interface between hospitals. What little infrastructure the HITECH act sketched out on this point was vague and inadequate. Clinicians and patients are most concerned with communication between hospitals or healthcare companies; miscommunication on this level is the cause of real pain for real people and in many cases actual death. In terms of exporting data from one HIS system and into another, it's not clear to me that this will every work without more infrastructure. The exported HL7 data from one organization is going to be of little use to another, they would need some very specialized software to mediate between the data in the exported HL7 file and their own systems. Importing it directly into their hospital information systems is simply not going to be possible; their systems won't understand the myriad of idiosyncratic decisions that the other organization has made, often in response to the specific systems they have purchased (scheduling, laboratory, scheduling, etc.)

nradov 8y ago
If we limit the scope to summary patient chart data, an HL7 C-CDA 2.1 CCD which gets a perfect scorecard can be imported into any modern inpatient or outpatient EMR/EHR application with pretty good fidelity. There will be a few edge cases and data mapping needed depending on the specific application, but generally not much. https://sitenv.org/scorecard/ https://sitenv.org/scorecard/ Other types of data are still problematic.
- lostlogin 8y ago
  > few edge cases It’s all edges. It’s really grim. And once you have it sorted out, another variation pops up and fails in some new and awful way. Trying to maintain charts with columns and rows for example, basic stuff, in is near impossible. Just when you crack it you find some down stream system you have no control over is transposing rows and messing up records. It’s critical stuff and it’s a mess.
  - nradov 8y ago
    I'm not sure what you mean there. If you put a table with rows and columns in the narrative text portion of a CDA that will be preserved across systems. At least I've never seen a real world application that actually modifies the pseudo-HTML narrative text beyond applying some basic style sheet formatting.
- nwhatt 8y ago
  The author of the article describes the problem as such: > When a patient with a complex medical history like Michael arrives under my care, it’s like opening a book to page 200 and being asked to write page 201. Even Epic doesn't have the ability to consolidate multiple CDA documents, or even write information directly to the chart. Each one requires manual review. Standards for exchange are not really the problem.

nradov 8y ago

If we limit the scope to summary patient chart data, an HL7 C-CDA 2.1 CCD which gets a perfect scorecard can be imported into any modern inpatient or outpatient EMR/EHR application with pretty good fidelity. There will be a few edge cases and data mapping needed depending on the specific application, but generally not much. https://sitenv.org/scorecard/ https://sitenv.org/scorecard/ Other types of data are still problematic.

lostlogin 8y ago
> few edge cases It’s all edges. It’s really grim. And once you have it sorted out, another variation pops up and fails in some new and awful way. Trying to maintain charts with columns and rows for example, basic stuff, in is near impossible. Just when you crack it you find some down stream system you have no control over is transposing rows and messing up records. It’s critical stuff and it’s a mess.
- nradov 8y ago
  I'm not sure what you mean there. If you put a table with rows and columns in the narrative text portion of a CDA that will be preserved across systems. At least I've never seen a real world application that actually modifies the pseudo-HTML narrative text beyond applying some basic style sheet formatting.
nwhatt 8y ago
The author of the article describes the problem as such: > When a patient with a complex medical history like Michael arrives under my care, it’s like opening a book to page 200 and being asked to write page 201. Even Epic doesn't have the ability to consolidate multiple CDA documents, or even write information directly to the chart. Each one requires manual review. Standards for exchange are not really the problem.