Interoperability remains a goal and challenge for many healthcare organizations, our recent CMIO 2010 Top Trends Survey shows. It’s a necessity for Chicago Alliance of Community Health Services, which was founded by four safety net health centers—Heartland Health, Erie Family Health Center, Howard Brown Health Center and Near North Health Services—and is engaged with 24 additional healthcare centers in 10 states.

With five years of clinical data in hand, and more accumulating daily, the Alliance is using clinical decision support (CDS) tools to build a high level of evidence-based care and export its findings to its centers and other healthcare organizations using a customized EMR (GE Healthcare).

Fred Rachman, MD, who is CEO of the Alliance, recently discussed CDS and what’s emerging down the line.

Are you exchanging data with other organizations?
We are exchanging data with other organizations [on] a couple of levels. Through our work with GE, we have a data warehouse that draws de-identified patient data from across all of the sites that are live on the EMR. We are able to then provide these clinical measure analyses as dashboards across all of the users of the EMR. These could be drilled down by individual organization, by site, by provider, by racial/ethnic or other disparity group, etc.

At the level of de-identified data, there’s complete exchange among the organizations. In terms of actual identified patient data, among the primary care organizations, the release of data [still mimicks] the way it would look on paper—permission has to be granted by the patient for data to be released and flow from one org to the other—but we are engaged in some limited health information exchange pilots.

Here in Chicago, our partner centers are working with our main hospital partner, Northwestern Memorial, and we have some exchange of data. The exchange is not yet an actual electronic import of the data directly into the record, but there’s an ability to view on both sides relevant patient data in the hospital setting and in the primary care setting of both institutions.  Looking ahead, a pilot project has identified granular data elements that could be exchanged in appropriate fields electronically.

As new clinics join the Alliance, is interoperability an issue?
Since all Health Centers in the Alliance collaboration commit to a uniform standardized set of data elements and capture methods, interoperability concerns are related largely to interfaces with other local data sources/repositories such as labs, hospitals and public health registries.

What standards (CCD, HL7, etc.) enable the Alliance to exchange data?
The Alliance maximizes adherence to data elements built upon national interoperability standards incorporated into GE's Centricity EMR, a CCHIT-certified EHR.

What integration issues does the Alliance face?
One of the continuous challenges going forward is that all of these uses of technology are predicated on having efficient and accurate data capture strategies.  We must assure that  clinicians are capturing data at the point of care, in the right way for the system to recognize it and use it for CDS, and to be recognized in calculating a performance measure.

This is one of the biggest challenges that we have today, because standardized data capture requires intensive ongoing training of clinicians to assure they appreciate the importance of sticking to those strategies. We come from a background as clinicians where we viewed the recording of healthcare information as a very personal act. That’s something that has to be unlearned. For clinicians, who have not bought into the payback that comes from this change, it becomes a barrier to adoption of the technology. This has been an area where we’ve had great deal of continued insight.

The second issue with regard to CDS is the way that it is presented to the clinician and where [it is integrated] in the workflow, which is both an art and a science. The field is still relatively young. As we’re seeing more practices adopting technology and getting more experience with its use, there will be continued development and learning about what forms and strategies of CDS and how it is integrated into practice to make it most useful and effective.