A wedding, a layover and building blocks led me to a marriage proposal. Resigned to a missed connection at O’Hare, I began to think about my niece’s wedding and her creative idea to get her guests engaged in her beautiful day. Next to the wedding party table was a shiny bowl filled with building blocks. She asked her guests to write down a special memory on a block and place it in the tall glass vase next to the bowl. What a perfect metaphor for a marriage; a relationship and a building blocks tower. When blocks are removed or forgotten, the relationship could teeter or topple. Restore the memories, and you will strengthen the relationship. The message was clear: there is strength in remembering.
What does this have to do with interoperability and legacy data (LD)? Like a venn diagram, I exist in two worlds: a consultant with an IT company and licensed clinical social worker. I have found a shade of gray between these worlds.
Diving into the discussion of LD and interoperability, LD provides building blocks to understand a patient in the historical context through the clinical narrative—an exercise in remembering. LD is the body of data containing observations from multiple clinicians over the years.
Why is this important?
Because EHRs are ultimately about the relationship between clinicians and patients they serve. LD can strengthen the relationship through important insights to a patient’s broader history. The result, a more comprehensive patient story. Knowing patients through the historical narrative promotes understanding. When patients are understood, they are likely to engage, and more importantly, participate--leading to improved outcomes.1
When my role as a licensed clinical social worker intersects with this discussion, I am acutely aware how patients with chronic mental illness are impacted. Historical data completes a story not always included in the current EHR.
EHR systems going forward can leave behind important historical narratives that include unknown facts, such as co-morbid illnesses, substance abuse, medication trials, traumatic brain injuries and previous diagnoses, to mention a few. This population of patients struggles as reliable historians. LD can provide a more complete diagnostic understanding.
I ask myself, “could access to LD increase the life expectancy of people who suffer with mental illness?” We are too familiar with the statistic that people with chronic mental illness can die 14-32 years earlier than the general population.2 The clarion call from the Office of the National Coordinator (ONC) to be a learning health system and person-centered should include LD. Key points: Access to LD could reduce the rise in diagnostic errors3, promote patient participation and reduce costs.
The goal to achieve interoperability must also include LD in order to develop a more comprehensive patient document to “produce a longitudinal record of lasting value…preserving this for future readers.” See the Value Statement on the HIMSS Health Story Project page.
Like a symphony composer, the challenge to achieve interoperability is to bring harmony to the disparate parts of patient’s protected health information (PHI). The roadmap to interoperability must strengthen a marriage between clinicians and information technology to include the necessary blocks to tell the patient’s story. Let’s toast to this promise!
Jeff Liddell, M.Div., M.S.W., L.C.S.W. is a licensed clinical social worker who has worked in emergency psychiatric services for the past 21 years. He is a consultant for Harmony Healthcare IT.
2 Colton and Manderscheid. Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Preventing Chronic Disease . 2006 Apr.