HIM 200 Module 3 Interoperability Short Paper Example

Why Records Still Travel by Fax: Interoperability at Brennan County Medical Center

[Student Name]

Southern New Hampshire University

HIM 200: Introduction to Health Information Technology

Module Three Short Paper

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Why Records Still Travel by Fax: Interoperability at Brennan County Medical Center

Brennan County Medical Center has had an electronic record for more than a decade, yet about 40% of the records it receives from other providers still arrive by fax. That gap between having electronic records and exchanging them is the interoperability problem. This paper explains what interoperability means, how data currently move in and out of the hospital, what research says about the benefits and barriers of exchange, how new standards and rules aim to help and what the HIM department can do.

Levels of Interoperability

Picture exchange as a stack of four layers. At the foundational level, one system can send data that another receives. At the structural level, the data arrive in a shared format so fields land in the right places. At the semantic level, both systems use common codes, such as standard terminologies for diagnoses, laboratory tests and medications, so the receiving system understands what the data mean. At the organizational level, policies, agreements and workflows make exchange routine. A faxed page achieves only the first layer: it arrives, but a person must read and file it.

How Data Move Today

Brennan County receives about 2,300 outside documents a month. Hospitals using the same record vendor send discharge summaries automatically through the vendor's network. The state health information exchange sends admission, discharge and transfer alerts when Brennan County patients visit other hospitals. A few clinics send summaries by secure direct messaging. Everyone else faxes, including most independent primary care practices and the regional cancer center. The HIM department scans and indexes each faxed document to the right patient and encounter, a task that occupies about 1.5 full-time staff.

Table 1. Outside Documents Received per Month by Method

Note. HIM department intake log, average of three recent months.

Does Exchange Improve Care?

The case for exchange rests on evidence. Menachemi et al. (2018) reviewed 24 studies of health information exchange and found that the seven with designs suitable for causal conclusions each found something good, whether fewer repeat scans, lower spending or fewer safety problems, and not one detected a downside. The review also noted that regional community exchanges showed benefits more often than networks run by one health system or one vendor. For Brennan County, faster access to outside records could mean fewer repeat scans in the emergency department and fewer medication errors at admission.

Why Exchange Lags

Holmgren et al. (2017) counted under 30% of U.S. hospitals in 2015 that performed all four exchange activities of finding, sending, receiving and integrating data, with integration lagging most. Everson and Adler-Milstein (2016) found that hospitals' engagement in exchange was associated with how dominant their record vendor was in the local market, suggesting that exchange flows most easily among users of the same product. That matches Brennan County's experience: exchange works with same-vendor hospitals and fails with everyone else.

Older Barriers That Persist

Vest and Gamm (2010) described persistent challenges for exchange organizations, including technical incompatibility, uncertain financial sustainability and competition between providers reluctant to share patients' data with rivals. Many of these remain. Brennan County's state exchange charges participation fees, and small practices see little direct benefit from paying them. Some competing hospitals share only what rules require.

FHIR and Application Programming Interfaces

A newer standard offers hope. Fast Healthcare Interoperability Resources, known as FHIR, breaks health data into small, standardized pieces, such as a medication or a laboratory result, that can be requested over the web. Mandel et al. (2016) described SMART on FHIR, a platform that allows an application to be written once and run across different record systems, much like smartphone apps run on any phone of the same type. Because federal rules now require certified systems to offer standardized FHIR-based interfaces, patients can use apps to download their records, and providers can build tools that work with many vendors.

Information Blocking Rules

Policy has shifted from encouraging exchange to penalizing its obstruction. Black et al. (2018) describe how the 21st Century Cures Act defined information blocking and set penalties for developers, exchanges and networks, with separate consequences for providers. Rules effective from 2021 require hospitals to give patients electronic access to most of their information without unnecessary delay, with specific exceptions, such as preventing harm or protecting privacy. For Brennan County, this means test results and notes generally appear in the portal promptly, a change that required HIM to review release policies.

The HIM Role in Exchange

Exchange creates work for HIM as well as reducing it. Each arriving document has to land in the correct person's chart, and a wrong match can place one person's information in another's chart. HIM staff maintain the master patient index, resolve possible duplicates and review documents that the system cannot match automatically. They also apply special protections, such as federal confidentiality rules for substance use disorder treatment records, and they manage the policies that decide which information can be shared, with whom and when.

Recommendations

Four steps are within Brennan County's reach this year, none of which requires replacing the record system. First, identify the ten clinics that fax the most and offer each help setting up secure direct messaging, which could shift a third of faxes. Second, give emergency department clinicians query access to the state exchange so they can pull outside records at the bedside. Third, improve patient matching by standardizing how registration staff enter names, addresses and phone numbers. Fourth, promote patient-facing FHIR apps through the portal so patients can carry their own records to specialists.

Measuring Progress

The HIM department can track progress with three simple measures: the share of outside documents received by fax, the number of documents requiring manual patient matching and staff hours spent scanning and indexing. A realistic target is to cut the fax share from 40% to 25% within a year.

Conclusion

Interoperability fails at Brennan County not because the technology is missing but because partners use different systems, exchange costs money and sharing has been optional. Evidence shows exchange improves care, new standards make it technically easier and federal rules now penalize blocking. With targeted outreach, better patient matching and HIM leadership, the fax tray can shrink.

References

Black, J. R., Hulkower, R. L., & Ramanathan, T. (2018). Health information blocking: Responses under the 21st Century Cures Act. Public Health Reports, 133(5), 610-613. https://doi.org/10.1177/0033354918791544

Everson, J., & Adler-Milstein, J. (2016). Engagement in hospital health information exchange is associated with vendor marketplace dominance. Health Affairs, 35(7), 1286-1293. https://doi.org/10.1377/hlthaff.2015.1215

Holmgren, A. J., Patel, V., & Adler-Milstein, J. (2017). Progress in interoperability: Measuring US hospitals' engagement in sharing patient data. Health Affairs, 36(10), 1820-1827. https://doi.org/10.1377/hlthaff.2017.0546

Mandel, J. C., Kreda, D. A., Mandl, K. D., Kohane, I. S., & Ramoni, R. B. (2016). SMART on FHIR: A standards-based, interoperable apps platform for electronic health records. Journal of the American Medical Informatics Association, 23(5), 899-908. https://doi.org/10.1093/jamia/ocv189

Menachemi, N., Rahurkar, S., Harle, C. A., & Vest, J. R. (2018). The benefits of health information exchange: An updated systematic review. Journal of the American Medical Informatics Association, 25(9), 1259-1265. https://doi.org/10.1093/jamia/ocy035

Vest, J. R., & Gamm, L. D. (2010). Health information exchange: Persistent challenges and new strategies. Journal of the American Medical Informatics Association, 17(3), 288-294. https://doi.org/10.1136/jamia.2010.003673