Pediatric Informatics: Computer Applications in Child Health (Health ...

404 J.H. Schneider
31.6.1 Data Relevance
An EMR typically contains much more information than what is needed for subsequent
care. An example is the timing of individual inpatient medication doses
that usually would not be useful in an outpatient follow up visit. As EMR and
e-prescribing adoption increases, the amount of information available to HIEs will
be overwhelming. 22 Critical information, such as medications on which a patient is
discharged from the hospital, is useful if summarized. One of many value-added
functions that HIEs can provide is aggregation and transmission of “medication
reconciliation” data (“a complete list of a patient’s current medications, including
herbal supplements and vitamins, reconciled with new medication orders to ensure
that no duplications, adverse interactions, incorrect dosages or omissions occur”). 23
Both hospitals and providers have struggled with providing complete listing of all
the medications that patients are on across all their locations of care.
HIE developers must decide which EMR/PHR data is important for aggregation.
Important elements might include advance directives, problem lists, procedure
histories, allergies, medications, immunizations, medical supplies, durable medical
equipment and laboratory/radiology test results. Other information, such as family
and social history, may be important but have less value to the function of the specific
HIE. A number of HIEs, e.g., Northern Illinois Physicians for Connectivity,
are using the ASTM Continuity of Care Record Standard (CCR). The CCR was
developed by clinicians and it contains a core set of health information designed
to be transmitted from one care location to another. HL-7 has worked with ASTM
to create the Continuity of Care Document, a document compatible with both the
CCR and the Clinical Document Architecture of HL-7.
31.6.2 Connection and Access
Once HIE developers have decided what information to collect, the next question is
how to obtain it. Some HIEs have data repositories and others do not. Each model
has limitations when handling EMRs and PHRs. The assumption of an HIE without
a repository is that the HIE-EMR/PHR connection is always available. If any EMR/
PHR connection is interrupted, the HIE will have incomplete information. This is
of particular concern in disasters, such as Hurricane Katrina, where PHRs are more
vulnerable to interruption than physician or hospital-based EMRs.
Alternatively, an HIE using a central repository of data has only the most
recently accessed data from EMR/PHRs. It may not necessarily be the most recent
data. Connectivity and availability are still issues, because if the EMR/PHR data
is updated locally without connection to the HIE, then the HIE records are incomplete.
If a HIE performs analytic processing of data, then it also needs to store and
track the database versions on which specific reports have been based, for auditing,
corrections, and medico-legal purposes.