CIMI - FHIR
Russ LeftwichAugust 11, 2015
Clinicians and Interoperability
• The universe of clinicians• State of interoperability … most places• The clinician as input device• Engaging clinicians in transformation
The future is here – it’s just not evenly distributed.
~ William Gibson
The future clinician is here – they’re just not evenly distributed.
~ Russ Leftwich
Remember the Game of Telephone?
average Medicare beneficiary:
7 providers
in 4 different organizations
in one year
How many of those 7 providers know who the
other 6 are and how to get in touch with them?
When a patient in the US first sees their primary care provider
after a stay in the hospital, 75% of the time that PCP does
not yet have the discharge summary
• 5 antihypertensive medications• 3 antidepressant medications• 2 oral hypoglycemics• Nashville got second CT scan• No such thing as MRI• No ACE inhibitors• No angioplasty• No statins
When I trained in the 1980’s
Physician Office
Living at Home
CBSOutpt. Rehab
Home Health
Adult Day Care
PACE
Assist LivingNursing Home
SNF
LTACH
IRF
Acute Care Hospital
Emergency Department
Urgent Care
Psych Hospital
Hospice Facility
Home Hospice
Outpt. Behav. Health
Acuity of Illness
Inte
nsi
ty o
f C
are
Adapted from Derr and Wolf, 2012
Low
High
High
Outpatient Testing/Pharmacy/DME
11
The Spectrum of Care has become Increasingly Complex
Clinician/Patient Observations
• Allergy/Intolerance list example–1960’s Clinical model–Missing data attributes/detail–91 % drug-allergy alert override rate
• Smoking history 44 places in database• Applying models to clinician input–Questionnaire/questionnaire response
Clinician Recruitment & Engagement
• Marketing: sell the problem, then solution• HL7 Health Professional membership• Specialty society organizational members• HL7 User Groups• Organizational collaborations – AMIA– AMDIS– MD EpiNet