Q: Exchanging information between different vendors' EHRs at least 10 percent of the time is one of the measures in the NPRM for meaningful use stage 2 that plenty of people are saying should be removed from the final rule. Given this example, what percentage of the time do you exchange records between different vendors EHRs?
Blair (pictured at left): Once this is up and running, and I look at this taking a few years because these networks have to be stood up and there are aspects to deal with around trust fabric, things like that, standards, directories. Once networks are up and running, once the EHR vendors have it in their versions, the functionality with workflow and it’s fairly-well used by the providers, once that happens it will be used in virtually all transitions because providers want to have this information going back and forth. We’re early on with this, we’re a reference implementation, and some of the vendors have started moving into production. Certainly where we see this already going into production, it will be used always on transitions. We’re starting to see the end users look for improvements to functionality they’ve been using for a while to leverage those capabilities. So I don’t think there will be any resistance on the provider side.

Miller: The reason for that is because as doctors adopt electronic health records, that is their clinical workflow. So having the information in a push fashion come into their EHR, doctors have described it as a holy grail of health information technology because it’s absolutely what they’re looking for to have the information in the patient’s EHR before and at the time they’re seeing the patient without having to hunt for it.

Q: So, as someone who is actually swapping medical records between vendors EHRs, do you think it makes sense to keep that measure in meaningful use Stage 2?
Blair: We believe it should be in Stage 2. Now, you may want to put provisions in there addressing if there’s not a connectivity opportunity available, but we do not believe it is an overly burdensome lift to have in there. I think that at Stage 3 they may want to markedly increase the threshold of usage, but we don’t think it’s too hard for Stage 2.

One other thing about usage: It’s just like e-prescribing in that as the functionality got better and better and pharmacies got more and more adept at it and the efficiencies started to come around it you’re starting to see the usage now. And providers that use it ubiquitously wouldn’t go back. I think the same thing will happen with this, except this has a stronger impact on clinical care.

Miller: And once the doctors start using Direct they wouldn’t go back to a non-push method like faxing because they see the value immediately. The other thing in terms of Stage 2 and Direct and these transitions of care is that our experience is the vendors are working hard right now, they see the value, that the doctors are interested in this, and they’re trying to develop products that meet those clinical needs – and I find that incredibly exciting. The vendors we’re in contact with, those participating very actively in the S&I framework around this topic, transitions of care, are exceedingly interested in making sure their product has clinical functionality clinicians need.

[Related: Hudson Valley care managers reduce readmissions in pilot program.]

This is actually a quote from Dr. Blair, but it’s my favorite description that we have a tremendous concentration of patient-centered medical homes here in the Hudson Valley and we feel strongly that Direct is going to really create a patient-centered medical community.

Q: Is that starting to happen?
Blair: It’s definitely starting in our community. We’re moving from the patient-centered medical home to the patient-centered medical neighborhood. I can’t claim that Direct is the catalyst for that, there are lot of other efforts in the Hudson Valley but Direct is front-and-center in our discussions of technical solutions for transitions between in-patient and ambulatory and between ambulatory settings with a closed-loop referral. That’s what Direct is doing for us. We’re looking at Direct in moving form the medical home to the medical neighborhood and connecting primary care and specialty hospital, ambulatory and long-term care.

Continue reading our interview with Drs. Blair and Miller on the final page...