by Tone Southerland
I spent the last two days at the national Beacon Community meeting in Salt Lake City entitled “Meaningful Use of EHRs and Other Technologies to Achieve Measurable Improvements in Health and Care Quality.”
Part of the purpose of this meeting was to bring together EHR solution providers and Beacon Community leaders to discuss the advancement of health IT and care coordination. The breakout sessions were effectively orchestrated by encouraging open discussion on topics such as data extraction and normalization, creating effective feedback loops and collecting/integrating patient reported information.
Begun by the Office of the National Coordinator for Health Information Technology (ONC), Beacon communities are health systems showing advanced use and integration of EHRs and data sharing interoperability programs. There are 17 regional Beacon communities in the country today, supported by ONC funding. Greenway has been involved in their advancement and connecting providers to these communities for some time, and it’s an important project seeking further integration with similar programs to continue to advance patient care.
One of these merging initiatives is including Beacons within the recently created REC Community of Practice (CoP). This is a huge step in the right direction as the charters given to both Regional Extension Centers and Beacons often intersect. Through this CoP we will be able to further explore some key innovation areas.
Data extraction and normalization is the process of moving data from EHR systems to Beacon Community systems. In some cases Beacons have partnered with Health Information Exchanges (HIEs), in other cases they have built their own solutions to collect and process EHR data directly. Data extraction is further broken down into two parts: data modeling and terminology mapping. Data modeling is ensuring that disparate systems agree on the structure of data. Terminology mapping addresses issues of crosswalks between different vocabularies, which is significantly more challenging because vocabularies do not always have one to one maps and they also may represent different aspects of a particular data element. For example, NDC codes to the manufacturer whereas RxNorm codes to the dose form so there might exist multiple NDC codes to a single RxNorm code.
Achieving standardization of Clinical Decision Support (CDS) among EHR providers and Beacons is a significantly more challenging goal, but it is doable if we can align appropriately and look to utilize existing standards to address this. The key to success here is the separation of content and transport, meaning that how questions are asked and how answers are processed is separate from the questions and answers themselves. Such an approach will facilitate rapid implementation across both population demographics as well as medical disciplines. This has been addressed in both IHE and HL7 and standards are available, the challenge will be in implementing these standards before the Beacon grants expire in 18 or so months.
Lastly we need to continue to pursue a fail fast approach uncovering issues sooner rather than later. In the software development world we call this an iterative or agile approach. The sooner issues are found the sooner they can be incorporated back into the development process and addressed appropriately.
I applaud the Robert Wood Johnson Foundation for sponsoring this event as well as Beacon Community leaders and fellow Electronic Health Record Association (EHR Association) members for traveling across time zones, (on a time-change weekend no less) in interest of increasing collaboration between groups to ultimately achieve better patient care.