Clinical Document Exchange Requires Workflow Considerations

The systems we all depend upon to provide healthcare and promote the health of individuals and populations continue to struggle with interoperability. However, as with any challenge, people and systems rise to address real needs. Interoperability requires diverse systems to exchange clinical information. Doing so is not easy, and neither is the implementation of the requisite process changes to support the flow of information.

Healthcare organizations nationwide have implemented systems that exchange clinical documents containing data needed for continuity of care. While recent statistics published by Health Affairs show an increase in the sending and receiving of health data, much of this exchange is happening within organizations, and integration of information from sources other than intra-organizational ones remains low. The research suggests, “progress is focused on moving information between hospitals, not on ensuring usability of information in clinical decisions.”

Health Story Project’s roundtable discusses how clinical document exchange fits into workflows

To increase understanding about how clinical document exchange fits into clinical workflows, the Health Story Project’s recent roundtable discussed how organizations across the care continuum package-up, send, receive, and process information. The roundtable presented very different approaches to achieving not only interoperability (a capability), but true interoperation (using this capability and delivering on its promise to improve health). Importantly, though, all such approaches used the consolidated-clinical document architecture (C-CDA) standard.

Roundtable panelists representing stakeholders from across the healthcare ecosystem, including clinicians, informaticists, and health IT vendors, discussed key aspects of workflow redesign required to leverage digital document exchange, including:

- The range of stakeholders required to execute a successful workflow re-design process;

- The triggers for the generation and consumption of C-CDA documents;

- The benefits attainable for care delivery and care coordination through workflow adjustments;

- The PUSH and PULL strategies for information gathering, as well as the corresponding approaches to selection of each.

People and teamwork play important roles in information exchange workflow redesign

The role people play in the redesign of information exchange workflows was a recurring theme of the roundtable. Panelists agreed that technical considerations represent a small portion of the challenges to be overcome. The rest depends on the people involved. Critical person-centered drivers of successful results included coordination with external stakeholders and communication about workflow changes coupled with workforce training to support them. Teamwork was needed to determine when, where, and how to make clinical workflow changes that contributed and used information now being exchanged via standard C-CDA documents.

An informal poll of roundtable participants revealed an increase in the use of additional types of C-CDA documents designed to convey encounter-specific data. The number of implementers exchanging longitudinal summary information for a patient via CCD documents is growing; the number of implementers exchanging C-CDA documents that summarize information pertaining to a single encounter appears to be on the rise as well.

Discussion panelists included:

  • Omar Bouhaddou, PhD, Informatician Contractor to Department of Veterans Affairs, Office of Interoperability
  • Michael Clifton, Software Developer, Epic
  • David Kaelber, MD, PhD, MPH, FACMI, Chief Medical Informatics Officer, MetroHealth
  • Holly Miller, MD, MBA, FHIMSS, Chief Medical Officer, MedAllies
  • Marie Swall, Lead Analyst, Contractor to Department of Veterans Affairs, Office of Interoperability
  • Mike Warner, Senior Solution Strategist, Cerner

Listen to the Health Story Project roundtable recording and review additional comments from our panelists in the Q&A document from the event.

Registration is open for our upcoming February roundtable. Learn how CDA documents are being used as attachments to make claims processing more efficient for payers and providers. Visit this link to sign up!