The ambitious goal of promoting interoperability requires entering the national policy fray, where health information exchange is at the heart of the legislative tangle. Dr. Lehmann recently co-authored a paper advocating that EHR systems better facilitate pediatric health information exchange (HIE). Dr. Lehmann and his co-authors write: “The promise of EHRs to improve the quality of care, increase safety, and reduce costs will only come to fruition when important clinical data are made available through exchange.” Their paper argues for incentivizing the implementation of Direct message systems among practices, hospitals, and emergency services.
Herein lies a prime example of how government regulation affects the research-clinical gap: Researchers have built Direct messaging capabilities, but the support and incentives to implement these capabilities have fallen by the wayside. What’s more, in some cases large hospitals are actually motivated to avoid implementing data sharing measures. If community pediatricians have EHRs that are interoperable with big hospitals, their dependency on those hospitals decreases. In one study, Dr. Lehmann identified a community pediatrician in Tennessee who attempted to submit a summary of care record to a local children’s hospital, but was informed that their EHR was not compatible with Direct messaging, and that it might take years for their IT department to build out that capability.1 Issues of interoperability, with the ultimate aim of better patient care, require perseverance and coordination with Washington. Lehmann and the AAP are doing their best to look out for independent pediatricians at the federal level; Vanderbilt’s academic efforts pay off in their support of the practical needs of community pediatricians.
Dr. Lehmann, through his AAP appointment, spends a lot of time negotiating with policymakers. He describes what it’s like to work with people on the Hill: “Committee staffers actually base decisions on scientific data. It doesn’t matter which side of the aisle you’re talking about; once we have the data they are willing to listen.”
Vanderbilt’s history of interactions with Washington validates this point. In 2004, President George W. Bush visited Vanderbilt to observe their HIT system before announcing the Office of the National Coordinator for Health Information Technology (ONC). “President Bush recognized that we were making a difference in patient outcomes because of the level of technology we had in place,” says Dr. Johnson.
Early conversations about Meaningful Use provided opportunities for Vanderbilt faculty to testify on the Senate floor. Of Vanderbilt’s interdisciplinary Innovation Center, Johnson says: “We bring together large groups of scientists, engineers and policy people so that we can show them what we’ve done, ask really cool questions together about what’s possible, or even discuss what hasn’t worked well.” Dr. Johnson and other faculty describe a willingness at Vanderbilt to recognize cracks in existing systems, and to develop creative solutions. Some of these solutions are born out of Vanderbilt’s education initiatives, like the new Masters in Applied Clinical Informatics. The master’s degree is directed toward health care professionals who want to be “more effective in management of data and systems,” says Dr. Lehmann, who directs the closely linked informatics fellowship. The informatics fellow rotates between medical and HIT departments, building bridges between disciplines. With the board certification of clinical informatics as a specialty in 2013, these programs are more relevant than ever.