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