HIM 560 Module 2 Interoperability Short Paper Example

Why Records Still Arrive by Fax: Interoperability Between Pelican Shoals Health and Its Clinics

[Student Name]

Southern New Hampshire University

HIM 560: HIM Informatics and Technology Infrastructure

Interoperability 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 Arrive by Fax: Interoperability Between Pelican Shoals Health and Its Clinics

Each weekday, the health information department at Pelican Shoals Health receives about 120 faxed pages from its own four rural clinics: lab results ordered at the clinics, visit notes for patients later admitted and referral letters. Two staff members spend most of their day scanning, indexing and matching these pages to the right patient. The clinics and the hospital both have electronic records, and both belong to the same organization. This paper explains why they still exchange paper and what it would take to stop.

What Interoperability Means

Two systems are interoperable when data can travel between them and the receiving system can act on what arrives. Writers usually break this into four levels. Foundational exchange just delivers a payload from sender to receiver. Structural exchange adds a shared format, which is what puts a lab value in the result field and a collection date in the date field of the receiving record. At the semantic level, both sides attach the same meaning to the content, which in practice means using common code sets, so the clinic's glucose test and the hospital's are recognized as one test. At the organizational level, contracts, policies and trust make exchange permissible in the first place. A fax reaches only the first level, and barely: an image of the data arrives, and a person has to read and re-enter it.

The Standards That Serve Each Level

Table 1 summarizes the main standards and how each could apply at Pelican Shoals.

Table 1. Interoperability Standards and Their Application at Pelican Shoals Health

Note. Prepared by the author from a review of the hospital's and clinics' interface capabilities.

Why FHIR Matters

Older standards move whole messages or documents from one system to another. FHIR divides clinical data into small units it calls resources, one for the patient, one for each encounter, one for each lab value, which other software can request through the same style of web interface that banking and retail apps use. The SMART on FHIR approach reported by Mandel et al. (2016) lets an application written once run inside different vendors' records by using FHIR resources and standard authorization. For Pelican Shoals, this means that hospital staff could, in principle, look up a clinic patient's recent results without an interface built specifically for each report. Both vendors now support FHIR application programming interfaces, although neither has been configured to share data with the other.

Why the Fax Persists

The standards exist, so the fax is not a technology gap. Vest and Gamm (2010) described barriers to health information exchange as technical, organizational and financial, and all three apply. The clinics were acquired from a physician group that chose its record vendor years before the purchase. Everson and Adler-Milstein (2016) found that hospitals were more likely to exchange data with organizations using the same vendor and that engagement in exchange was associated with a vendor's dominance in the local market. Pelican Shoals is a small customer of both vendors, and each quoted a five-figure fee for a results interface.

Patient matching is a second barrier. The clinics and hospital assign different record numbers, and without a shared master patient index, staff must match faxed pages by name and birth date. Automating exchange without solving identity would simply move matching errors from paper into the record. Finally, no one owns the problem. The clinics see faxing as the hospital's issue; the hospital's information technology team sees it as a clinic request that has never been funded.

The Policy Setting

Federal policy now pushes in the same direction. The 21st Century Cures Act of 2016 prohibits information blocking, meaning practices that unreasonably interfere with access to, exchange or use of electronic health information, and health care providers are among the parties it covers. The rules also require certified record systems to offer standard FHIR interfaces for patient and population data. These provisions do not force Pelican Shoals to build a clinic interface, but they remove the argument that the technology is unavailable and raise the question of why an organization's own clinics cannot share data electronically with it. For a health information director, that question is a useful lever with leadership.

Three Steps Toward Electronic Exchange

First, the hospital should build a single results interface using HL7 version 2 from the clinics' lab module to the hospital record, which covers most of the faxed pages at a known cost. Second, a shared patient identifier should be established by linking clinic and hospital record numbers through the hospital's master patient index, with a steward reviewing uncertain matches. Third, the hospital should ask both vendors to enable their FHIR interfaces for read-only access to clinic visit summaries, and should join a national exchange network through its record vendor so that records from outside providers can arrive the same way. Each step reduces scanning and improves safety, and the first could be complete within six months.

What Would Change for Health Information Staff

If the three steps succeed, the two staff members who now scan and index faxes would move to reviewing uncertain patient matches and monitoring interface queues, work that requires more judgment and protects the record better. The department would also gain a measure it lacks today: how many outside documents arrive as data rather than images. That measure would show leaders whether their investment is working.

Conclusion

The fax between Pelican Shoals Health and its clinics survives because of vendor differences, unresolved patient identity and unclear ownership, not because standards are missing. A results interface, a shared identifier and FHIR access would move the organization from sending pictures of data to exchanging data that both systems understand.

References

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

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

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