Enhancing a Commercial EMR with an Open, Standards-Based Publish-Subscribe Infrastructure.

Intermountain Healthcare has designed and implemented a publish-subscribe (PubSub) infrastructure to support essential event processing workflows across our organization. A recent implementation of a commercial EMR highlighted the need to provide this capability on top of the EMR to support external applications and services that require access to triggering events within the EMR. A description of the PubSub architecture is presented. Use cases for health information exchange, public health reporting, and pulmonary embolism diagnosis that utilize PubSub are described, along with benefits of using the paradigm. Besides providing support for these external applications, the PubSub infrastructure allows additional event handling functionality not available in the commercial EMR. The open, standards-based nature of the design should allow other organizations to implement the system in their information systems environment.

Who Is Your Doctor? Analysis of Patient-Reported and EHR-Imputed Primary Care Physician.

Significant efforts have been made to improve physician-to-physician communication and care coordination during transition of care in order to reduce adverse events and readmissions. As electronic health records (EHRs) become widely available, many hospitals have implemented physician collaboration and hand-off tools to automatically send admission notifications, discharge summaries, and pending laboratory results to a patient's primary care physician (PCP). However, the effectiveness of such tools depends on a fundamental question that remains unstudied: who is the patient's PCP? Missing or outdated PCP information may become the bottleneck to effective patient-centered care coordination regardless of existing efforts on promoting interoperability among healthcare providers. In this paper, we characterized patient-reported PCPs and experimented with an imputation algorithm that automatically infers a patient's primary provider based on patient-provider encounter data. We compared the imputation results with patient-reported PCPs and suggested practical uses of our findings.

Improving Clinical Data Integrity by using Data Adjudication Techniques for Data Received through a Health Information Exchange (HIE).

Growing participation in Healthcare Information Exchange (HIE) has created opportunities for the seamless integration of external data into an organization's own EHR and clinical workflows. The process of integrating external data has the potential to detect data integrity issues. Lack of critiquing external data before its incorporation can lead to data unfit for use in the clinical setting. HIE data adjudication, by detecting inconsistencies, physiological and temporal incompatibilities, data completeness and timeliness issues in HIE data, facilitates corrective actions and improves clinical data integrity.