Sharing medical records between different vendors' EHRs is one of the meaningful use Stage 2 measures that some folks would like to see yanked – but not MedAllies' Holly Miller, MD, or John Blair, MD.

In fact, Miller (pictured at left) will be demonstrating how MedAllies does just that this week during ONC’s Direct Implementation and Adoption Summit in Washington, D.C.on Thursday and Friday.

Prior to the summit, Government Health IT spoke with Blair and Miller, CEO and CMO, respectively, of MedAllies, about why that EHR interoperability measure should not only remain in Stage 2, but also be ratcheted-up in Stage 3. They also discussed how the Direct protocol that enables MedAllies' closed-loop referral system is serving as a technological foundation upon which the Hudson Valley, N.Y. area is moving beyond a group of patient-centered medical homes and into what they call patient-centered medical neighborhoods. Each also offered a prediction of what Amazon, eBay or Facebook might one day might be.

Q: What is it you’ll be demonstrating at the ONC event this week?
Miller: Essentially, one of the biggest issues in healthcare right now is the fact that as patients go through care transitions, when the clinicians need to take care of the patients in the new environment but do not have information about the patient, it puts the patient at risk and it delays and increases the cost of healthcare. So it makes healthcare inefficient and, of course, creates a dangerous environment. Some examples of this, and I’m a primary care physician, so I’ve sent patients for referrals and when that patient comes back to my office needing to actually ask the patient what the other doctor said because I have no information from the doctor and so for all I know the medications might have changed. I’m flying blind. If I’m unaware the medication changed, I could prescribe something that is dangerous.

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So in the closed-loop referral we’re demonstrating, a patient who has seen their primary care physician gets sent for a consultation with a specialist. The information while the patient is with the primary care physician goes to the specialist, very specific information about what’s needed, what any questions are, critical information about the patient such as their demographic, their medications, their problem lists, allergies and then other information the specialist would need to care for the patient. And then once the patient has seen the specialist, the information about the consultation goes back to the primary care physician.

Q: And the primary care physician gets to keep that information? Or is it a temporary view?
Miller: In both cases, the CDA document would be stored in the EHR. So what we’re really excited about, working with various EHR vendors, in this instance with Greenway and NextGen, the information goes from disparate electronic health records through the MedAllies HISP and then is stored in both the electronic health records.

Q: So that’s actual exchange of health information – which might seem a nitpicky point, but this afternoon I was speaking with the executive director of an HIE who said, "exchange is an interesting word right now," because in many cases, say, an ED clinician might be able to view a patient record for a limited time, such as 20 minutes: not an uncommon scenario.
Miller: That’s right and there’s a tremendous difference between health information exchange and Direct. Direct is clinician-to-clinician. The model is really what clinicians do every day as patients transition across care environments. And it’s a push model, so I as a primary care physician, if I’m asking a cardiologist to do a consultation, I’m sending the information about that patient that the cardiologist needs to treat the patient.

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So there are certain things that might always get sent, then things specific to the cardiologist, such as tests that I’ve done that pertain to cardiology, or other lab results like an echocardiogram. A dermatologist, they don’t need to see that information, they want a photograph I took of the rash and something along those lines. The other thing that’s an important distinction is that under HIPAA when there’s communications between physicians, consent is not required by the patient, it’s presumed.

Continue reading our interview with Drs. Blair and Miller on the next page...