Using HIE to Enhance EMRs

Join us Wednesday, 6 October, at 16:00 (CEST) to join a discussion around how health information exchange can serve the needs of population health, but providers on the front lines of care are working within their EMRs. How can the HIE serve providers and patients on the front lines of care? A lot of effort has gone into getting data from EMRs into an HIE, but what about the other direction? How can HIE data best serve the needs of providers on the front lines of care working with EMRs? What APIs, integrations, or applications exist or would be most helpful for an HIE to provide in service to EMRs.

Join the session here

You can post your questions ahead of, during, or after the session. Our moderators will check this thread for questions, and select some for responding to in the session, or follow up after the session has ended.

Feel free to respond to other questions or add to them if you have something to follow up with.

@burke

1 Like

Here are some notes from our session:

  • Do we have examples of how HIE data are being used in EMRs today?
    • Kenya’s work with NASCOP (HIV) and KenyaEMR
    • Nigeria’s work with NDR
      • Currently implemented for the HIV program in Nigeria
      • Multiple EMRs exchanging data with NDR through XML exports
      • There is still a challenge of unique identifier for patients who receive care in multiple sites (ID duplication)
      • There is the challenge of internet penetration and stable power
      • Currently working on identifying patients through Finger Print capture
      • NDR aggregates patient level data into aggregate level National indicators
    • Uganda Cancer Institute planning to use HIE as an application for cancer screening
      • Currently, Ugandans getting cancer screening going through a number of services on paper
      • Planning on screening with point of care system, putting data into the HIE and then pushing to EMR
      • Plan on using National ID for identifying patients
  • How would we want HIE data to be used within EMRs?
    • Having data within a local EMR regardless of where the encounters occurred is very helpful in care coordination (i.e., encounters from HIE pulled into local EMR)
    • Comment by Peter Ricketts (in chat): Our strategy is to start working with various local subject matter experts to develop their requisite data sets which will be defined in using our OCL Terminology Service. Once the health exchange is up and running, the OCL terminology service will define what data can be shared within the HIE (e.g an Echocardiogram report). The aim is then to get the legislative framework to support those dataset mandates to define what should or could be shared
  • How can HIE data best serve providers?
    • If providers can authenticate to an HIE, it could be used as a regional patient chart if the HIE provides a view
    • EMRs could pull down patient data from the HIE and display it to users
      • In Rwanda, the EMR would query the HIE for a patient’s record during registration and keep those data temporarily to show to providers.
  • What application and/or integrations exist?
    • Not a lot of examples quite yet
  • How would EMR identify patient to HIE?
    • Implementation-specific identifiers are useful to have when national ID is unavailable
    • Identifying patients in HIE can be a large challenge
    • Could/should the HIE create its own patient identification (e.g., username & password) for all patients in the HIE
      • Patients could grant access to record (if they’re conscious; otherwise, would need a “break the glass” option for emergency access)
  • What types of data would an EMR need from HIE?
    • Patient encounters from other facilities
    • Pharmacy records (prescription or dispensing)
    • Adverse Drug Reactions (allergies & intolerances)
    • Imaging
    • Lab results
    • Immunization (COVID-19 vacination)
    • Conditions / Problem list (sometimes can become a very long, unmanaged list)
  • Does EMR need to know of changes to records from HIE? If so, how would it find out?
    • Only the owner of that data should be able to update it. However an interesting problem is maging diagnoses centrally
  • When would EMR get records?
    • When patient is registered in the EMR
    • On-demand (e.g., provider doing chart review)
    • I think it should be available once linked with the Client Registry. However it would be nice to revoke access to patient records if a Doctor’s License gets revoked or a facility is closed
  • What types of policies need to be considered? Should every EMR have access to all data within the HIE? When data from EMR 1 are pulled down from HIE to EMR 2, who owns those data?
    • Provenance needs to be tracked (e.g., if data are downloaded from the HIE into an EMR)
    • Governance issues can vary depending on a country’s laws. In many cases, where care
    • Patients should be able to approve access to their medical data (What happens in an emergency situation)
    • Need to accommodate situations where a patient is unconscious or unable to grant access
    • Need to consider how things would work when power or internet access are unavailable or intermittently available
1 Like

@here are there examples on how I can simulate openHIE for existing use case? say inter-oping of two openmrs distribution EMRs