Running Head: TOO MUCH DATA, NOT ENOUGH DATA 1 Too Much Data, Not Enough Data: Providing Relevance to Care Connectivity Consortium Providers and Their Patients Kathleen Merkley, MS, RN, FNP, ANP Electronic Clinical Information Management Implementation Director Intermountain Health Care University of Utah College of Nursing “In partial fulfillment of the requirements for the Doctor of Nursing Practice”
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Running Head: TOO MUCH DATA, NOT ENOUGH DATA 1
Too Much Data, Not Enough Data: Providing Relevance to Care Connectivity
Consortium Providers and Their Patients
Kathleen Merkley, MS, RN, FNP, ANP
Electronic Clinical Information Management Implementation Director
Intermountain Health Care
University of Utah College of Nursing
“In partial fulfillment of the requirements for the Doctor of Nursing Practice”
TOO MUCH DATA, NOT ENOUGH DATA 2
Table of Contents
Executive Summary ………………………………………………………………………………6
Introduction………………………………………………………………………………………..7
Significance of the Project………………………………………………………………………...9
From: [email protected] Sent: Friday, August 17, 2012 10:28 AM To: Kathleen Merkley Subject: ERICA IRB New Study Approval
IRB: IRB_00058678
PI: Kathleen Merkley
Title: Electronic Data Relevance
Study
Thank you for submitting your request for approval of this study. The IRB has administratively reviewed your application and a designated IRB member has determined that your study is exempt from further IRB review, under 45 CFR 46.101(b), Category 2, from
the Federal regulations governing human research. It is the policy of the University of Utah that all human subject research which is exempt under this section will be conducted in accordance with (1) the Belmont report (http://ohrp.osophs.dhhs.gov/humansubjects/guidance/belmont.htm ), (2) this institution's administrative procedures to ensure valid
claims of exemption, and (3) orderly accounting for such activities. All research involving human subjects must be approved or exempted by the IRB before the research is conducted (http://www.research.utah.edu/irb/guidelines/pdf/IGS/IGS-ExemptResearch.pdf).
Since this determination is not an approval, it does not expire or need renewal. This determination of exemption from continuing IRB review only applies to the research study as submitted to the IRB
and you are expected to follow the protocol as outlined. Before
implementing any changes in the study, you must submit an amendment application to the IRB and secure either approval or a determination of exemption.
Please remember to submit final IRB approval from Intermountain Healthcare to the University Utah IRB by way of Amendment. If you have questions about this, please contact our office at 581-3655 and we will be happy to assist you. Thank you again for submitting your proposal.
Click IRB_00058678 to view the application. Please take a moment to complete our customer service survey. We
Subject: Providing Data Relevance to Care Connectivity Consortium Members
October 7, 2012
Thank you for agreeing to participate in this survey. Your inputs will be extremely valuable in
our efforts to determine which data components should be included related to provider type,
patient acuity, severity and chronicity, as well as how data can be considered more trustable and
timely.
As a respondent, the results of the survey will be displayed on the CCC Wiki by the end of
November. Thank you for your participation and please know the time you spent in providing
feedback will be utilized to enhance data sharing between consortium members.
Sincerely,
Kathleen Merkley,APRN, MS, FNP Chris Wood, MD
ECIM Implementation Medical Director, InformationSystems
Intermountain Healthcare Intermountain Healthcare
TOO MUCH DATA, NOT ENOUGH DATA 89
Appendix G
Recommendations – Care Connectivity Consortium
TOO MUCH DATA, NOT ENOUGH DATA 90
CCC Recommendations
1. Data Set Recommendations
Data/Information Type
Advanced directives
Behavioral health history
Cognitive abilities
Diet history
Discharge summaries
Electrocardiogram images
Family history
Genome information
Growth records
Health maintenance information
Health insurance
Immunization history
Laboratory results
Medical devices
Mobility/falls risk
Operative summaries
Patient goals
Patient instructions
Pending tests and procedures
Procedure results –
invasive/noninvasive
Progress notes
Provider information and telephone
number
Physical activity
Plain radiographic images
Radiology Tests (report)
CT, endoscopy, nuclear medicine
scan, MRI, ultrasound
Radiology Tests (images)
CT, endoscopy, nuclear medicine
scan, MRI, ultrasound
Review of systems
Special needs
Social history
Vital signs
TOO MUCH DATA, NOT ENOUGH DATA 91
2. Data per Specialty Recommendations (top 10)
LIP Inpatient
Laboratory Results
Radiology Test Reports
Discharge Summaries
Advanced Directives
Provider Information
Medical Devices
Vital Signs
Procedure Reports
Operative Tests
Radiology Test Images
ED LIP
Operative Summaries
Procedure Reports
Plain Radiographic Images
Radiology Test Results
Vital Signs
Electrocardiograms
Immunizations
Provider Information
Family History
Lab Results
Pediatric LIP
Discharge Summaries
Immunizations
Lab Results
Radiology Tests
Provider Information
Plain Radiographic Images
Growth Records
Procedure Results
Radiology Test Images
Operative Summaries
TOO MUCH DATA, NOT ENOUGH DATA 92
Outpatient LIP
Discharge Summaries
Laboratory Reports
Medical Devices
Advanced Directives
Procedure Reports
Operative Summaries
Immunization History
Health Maintenance Records
Electrocardiograms
Vital Signs
Inpatient Nursing
Laboratory Results
Advanced Directives
Procedure Reports
Immunizations
Special Needs
Medical Devices
Pending Tests
Progress Notes
Radiology Reports
Mobility/Falls Risk
Outpatient Nursing
Discharge Summaries
Family History
Laboratory Results
Operative Summaries
Progress Notes
Vital Signs
Procedure Results
Health Insurance
Radiology Test Reports
Special Needs
TOO MUCH DATA, NOT ENOUGH DATA 93
1. Critical Data Recommendations (top ten)
Inpatient LIP
Electrocardiograms
Advanced Directives
Operative Summaries
Progress Notes
Radiology Tests – Images
Behavioral Health History
Diet
Health Maintenance
Plain Radiographic Images
Radiology Tests - Reports
Pediatric LIP
Advanced Directives
Discharge Summaries
Laboratory Results
Radiology Tests – Reports
Vital Signs
Procedure Notes
Plain Radiographic Images
Operative Summaries
Progress Notes
Electrocardiograms
ED LIP
Advanced Directives
Radiographic Tests - Images
Behavioral Health History
Cognitive History
Discharge Summaries
Electrocardiograms
Provider Information
Diet
Family History
Growth Record
TOO MUCH DATA, NOT ENOUGH DATA 94
Inpatient Nursing
Electrocardiograms
Review of Systems
Operative Reports
Discharge Summaries
Radiology Tests – Reports
Radiology Tests – Images
Plain Radiographs
Pending Tests
Progress Notes
Vital Signs
2. Priority Data (top five)
Priority Data
Discharge Summaries
Laboratory Data
Advanced Directives
Radiographic Tests - Reports
Electrocardiograms
3. Data Lifecycle Recommendations
Data Type Distribution 1 Bi-Modal Distribution
Radiographs 1 week – 3 months Within 5 years
Electrocardiograms 1 week – 1 month 1 -5 years
Labs 1 week – 1 month 1-5 years
Procedures 1 week – 1 month Within 5 years
Discharge Summaries 5 years to complete
Problem lists 5 years to complete
Medications Within 5 years
Vital Signs Within 1 week
TOO MUCH DATA, NOT ENOUGH DATA 95
Appendix H
Electronic Data Relevance Emergency Survey
TOO MUCH DATA, NOT ENOUGH DATA 96
Emergency Survey
Electronic Data Relevance Survey
With the advent of electronic health information exchange across health care systems, there are a
number of questions about the actual data and information that should be exchanged to provide
better coordination and improved patient care. These questions are as follows:
Very little research has been conducted on what types of data and information would be
most important to exchange and the format in which it should be reviewed.
Exchanging data or information across healthcare systems may introduce inconsistent
results. This results in the need to understand who should be expected to resolve such
inconsistencies.
There is limited understanding of the factors that might influence how trustworthy data or
information may be considered went sent from another healthcare system.
Responses to this survey will begin to address these issues. Please answer the following
questions.
Identification of Most Valuable Data When choosing which data or information to send from one institution to another, the question of
relevance becomes a priority. Although no regulations have been defined, legal precedence
indicates that a clinician is responsible for information exchanged by another health care system.
In addition there is a concern about overwhelming clinicians with too much information that may
not be relevant. Actual data or information to be exchanged (to provide care coordination and the
best care) are in question. It is important to understand out of all existing data and information,
what is most relevant when providing clinical care.
TOO MUCH DATA, NOT ENOUGH DATA 97
1. As a clinician treating patients from another healthcare system in your emergency
department you understand you could receive any or all data or information from
that system. You already have immediate electronic access to your patients’ allergy,
medication and problem list. Please indicate what additional data/information
would be important for you to have in caring for your ED patients.
First, check the boxes next to all data and information types that you think would be
important in treating critical ED patients and then all ED patients.
Second, rank up to 5 data types you think would be MOST RELEVANT for you to
have in treating your ED patients, with “1” being the single most important type of
data and “5” being the fifth most important type of data or information.
Data/Information Type Critical
ED
Patients
All ED
Patients
Priority
Advanced directives
Behavioral health history
Cognitive abilities
Diet history
Discharge summaries
Electrocardiogram images
Family history
Genome information
Growth records
Health maintenance information
Health insurance
Immunization history
Laboratory results
Medical devices
Mobility/falls risk
Operative summaries
Patient goals
Patient instructions
Pending tests and procedures
Procedure results –
invasive/noninvasive
Progress notes
Provider information and telephone
number
Physical activity
Plain radiographic images
Radiology Tests (report)
CT, endoscopy, nuclear medicine
TOO MUCH DATA, NOT ENOUGH DATA 98
scan, MRI, ultrasound
Radiology Tests (images)
CT, endoscopy, nuclear medicine
scan, MRI, ultrasound
Review of systems
Special needs
Social history
Vital signs
Other (please specify)
Presentation of Received Data
Data and information received from another health care system may be received electronically
by clinicians in the form of a single document or incorporated into the patient’s current
electronic medical record (EMR).
2. In your opinion, should data/information received from another healthcare system
be displayed as a separate electronic document and/or as integrated data within the
patient’s current electronic medical record?
a. Received as a separate electronic document?
b. Received as integrated data/information within the patient’s current EMR?
c. Received as both a separate electronic document and as integrated data/information
within the patient’s current EMR?
Reconciliation of Received and Existing Data
If data/information sent from another healthcare system are integrated within the patient’s
current EMR, there may be a need to reconcile duplications, inconsistencies and contradictions.
Part of this reconciliation will be completed by the computer but human interaction/decision
making will likely be needed as well.
TOO MUCH DATA, NOT ENOUGH DATA 99
3. Do you think a clinician should be required to reconcile inconsistencies between
data/information received from another healthcare system and the current EMR for
a patient they are currently caring for?
a. Yes
b. No, reconciliation is not necessary.
c. Only as needed on a case by case basis.
4. If such reconciliation of data or information was required, who do you think should
complete the reconciliation?
a. The physician caring for the patient in the receiving institution.
b. The nurse caring for the patient in the receiving institution.
c. The first licensed care giver encountering the patient in the receiving institution.
d. Should be dependent on the data shared (examples would be: pharmacist
reconciling medications, physicians reconciling labs, problems or allergies, and
nursing reconciling patient goals).
e. Other___________________________
Trustworthiness of Data
5. How IMPORTANT would each of the following conditions be in deciding if you
trust the data/information received from another healthcare system?
TOO MUCH DATA, NOT ENOUGH DATA 100
a. The strength of a working relationship with the provider from an outside
healthcare system who ordered or performed the procedure or otherwise prepared
the information. Not Important Somewhat Important Neutral Important Very Important Don’t Know
b. The reputation of the healthcare organization sending the data/information. Not Important Somewhat Important Neutral Important Very Important Don’t Know
c. Trusting the integrity of the health data exchange. Not Important Somewhat Important Neutral Important Very Important Don’t Know
d. Knowing the type of provider who ordered or performed the procedure or
otherwise prepared the information (specialist vs. generalist). Not Important Somewhat Important Neutral Important Very Important Don’t Know
e. The complexity of the patient. Not Important Somewhat Important Neutral Important Very Important Don’t Know
f. I can repeat the test/procedure and the repeated test/procedure will again be
reimbursed. Not Important Somewhat Important Neutral Important Very Important Don’t Know
g. How well the data/information is organized in a reliable (i.e. is the format
intuitive). Not Important Somewhat Important Neutral Important Very Important Don’t Know
h. I trust the completeness, timeliness and accuracy of the data? Not Important Somewhat Important Neutral Important Very Important Don’t Know
Useful Date Ranges of Data
TOO MUCH DATA, NOT ENOUGH DATA 101
6. When looking for electronic health information exchanged across health care
systems what is the general time limit, by category that data/information is useful.
a. Vital Signs
Within 1 week
Within 1 month
Within 3 months
Within 6 months
Within 1 year
Within 5 years
Other
b. Laboratory Results
Within 1 week
Within 1 month
Within 3 months
Within 6 months
Within 1 year
Within 5 years
Other
c. Procedures
Within 1 week
Within 1 month
Within 3 months
Within 6 months
Within 1 year
Within 5 years
Other
d. Previously administered medications
Within 1 week
Within 1 month
Within 3 months
Within 6 months
Within 1 year
Within 5 years
Other
TOO MUCH DATA, NOT ENOUGH DATA 102
e. Radiographs
Within 1 week
Within 1 month
Within 3 months
Within 6 months
Within 1 year
Within 5 years
Other
f. Electrocardiograms
Within 1 week Within 1 month Within 3 months Within 6 months Within 1 year Within 5 years Other
g. Problem List
Within 1 year
Within 2 years
Within 5 years
Complete
Other
h. Discharge Summaries
Within 1 year
Within 2 years
Within 5 years
Complete
Other
8. What is your profession?
Other ____________________________________________
TOO MUCH DATA, NOT ENOUGH DATA 103
Appendix I
Electronic Data Relevance Survey – Inpatient Nursing
TOO MUCH DATA, NOT ENOUGH DATA 104
In-Patient Nursing Survey
Electronic Data Relevance Survey
With the advent of electronic health information exchange across health care systems, there are a
number of questions about the actual data and information that should be exchanged to provide
better coordination and improved patient care. These questions are as follows:
Very little research has been conducted on what types of data/information would be most
important to exchange and the format in which it should be reviewed.
Exchanging data or information across healthcare systems may introduce inconsistent
data. This results in the need to understand who should be expected to resolve such
inconsistencies.
There is limited understanding of the factors that might influence how trustworthy data or
information may be considered went sent from another healthcare system.
Responses to this survey will begin to address these issues. Please answer the following
questions.
Identification of Most Valuable Data When choosing which data or information to send from one institution to another, the question of
relevance becomes a priority. Although no regulations have been defined, legal precedence
indicates that a clinician is responsible for data/information exchanged by another health care
system. In addition there is a concern about overwhelming clinicians with too much
data/information that may not be relevant. Actual data/information to be exchanged (to provide
care coordination and the best care) is in question. It is important to understand out of all
existing data, what is most relevant when providing clinical care.
TOO MUCH DATA, NOT ENOUGH DATA 105
1. As a clinician caring for patients from another healthcare system on your unit you
understand you could receive any or all data/information from that system. You
already have immediate electronic access to your patients’ allergy, medication and
problem list. Please indicate what additional data/information would be important
for you to have in caring for your hospitalized patients.
First, check the boxes next to all data and information types that you think would be
important in treating your patients.
Second, rank up to 5 data/information types you think would be MOST
RELEVANT for you to have in treating your patients, with “1” being the single
most important type of data /information and “5” being the fifth most important
type of data/information.
Data/Information Type Critical
Patients
All
Patients
Priority
Advanced directives
Behavioral health history
Cognitive abilities
Diet history
Discharge summaries
Electrocardiogram images
Family history
Genome information
Growth records
Health maintenance information
Health insurance
Immunization history
Laboratory results
Medical devices
Mobility/falls risk
Operative summaries
Patient goals
Patient instructions
Pending tests and procedures
Procedure results –
invasive/noninvasive
Progress notes
Provider information and telephone
number
Physical activity
Plain radiographic images
Radiology Tests (report)
TOO MUCH DATA, NOT ENOUGH DATA 106
CT, endoscopy, nuclear medicine
scan, MRI, ultrasound
Radiology Tests (images)
CT, endoscopy, nuclear medicine
scan, MRI, ultrasound
Review of systems
Special needs
Social history
Vital signs
Other (please specify)
Presentation of Received Data
Data and information received from another health care system may be received electronically
by clinicians in the form of a single document or incorporated into the patient’s current
electronic medical record (EMR).
2. In your opinion, should data/information received from another healthcare system
be displayed as a separate electronic document and/or as integrated data within the
patient’s current electronic medical record?
d. Received as a separate electronic document?
e. Received as integrated data within the patient’s current EMR?
f. Received as both a separate electronic document and as integrated data within the
patient’s current EMR?
TOO MUCH DATA, NOT ENOUGH DATA 107
Reconciliation of Received and Existing Data
If data /information from another healthcare system are integrated within the patient’s current
EMR, there may be a need to reconcile duplications, inconsistencies and contradictions. Part of
this reconciliation will be completed by the computer but human interaction/decision making
will likely be needed as well.
3. Do you think a clinician should be required to reconcile inconsistencies between
data/information received from another healthcare system and the current EMR for
a patient they are currently caring for?
a. Yes
b. No, reconciliation is not necessary.
c. Only as needed on a case by case basis.
4. If such reconciliation of data or information was required, who do you think should
complete the reconciliation?
a. The physician caring for the patient in the receiving institution.
b. The nurse caring for the patient in the receiving institution.
c. The first licensed care giver encountering the patient in the receiving institution.
d. Should be dependent on the data shared (examples would be: pharmacist
reconciling medications, physicians reconciling labs, problems or allergies, and
nursing reconciling patient goals).
e. Other___________________________
TOO MUCH DATA, NOT ENOUGH DATA 108
Trustworthiness of Data
5. How IMPORTANT would each of the following conditions be in deciding if you
trust the data/information received from another healthcare system?
a. The strength of a working relationship with the provider from an outside
healthcare system who ordered or performed the procedure or otherwise prepared
the information. Not Important Somewhat Important Neutral Important Very Important Don’t Know
b. The reputation of the healthcare organization sending the data. Not Important Somewhat Important Neutral Important Very Important Don’t Know
c. Trusting the integrity of the health data exchange. Not Important Somewhat Important Neutral Important Very Important Don’t Know
d. Knowing the type of provider who ordered or performed the procedure or
otherwise prepared the information (specialist vs. generalist). Not Important Somewhat Important Neutral Important Very Important Don’t Know
e. The complexity of the patient. Not Important Somewhat Important Neutral Important Very Important Don’t Know
f. I can repeat the test/procedure and the repeated test/procedure will again be
reimbursed. Not Important Somewhat Important Neutral Important Very Important Don’t Know
g. How well the data is organized in a reliable (i.e. is the format intuitive). Not Important Somewhat Important Neutral Important Very Important Don’t Know
h. I trust the completeness, timeliness and accuracy of the data? Not Important Somewhat Important Neutral Important Very Important Don’t Know
TOO MUCH DATA, NOT ENOUGH DATA 109
Useful Date Ranges of Data
6. When looking for electronic health information exchanged across health care
systems what is the general time limit, by category that data/information is useful.
a. Vital Signs
Within 1 week
Within 1 month
Within 3 months
Within 6 months
Within 1 year
Within 5 years
Other
b. Laboratory Results
Within 1 week
Within 1 month
Within 3 months
Within 6 months
Within 1 year
Within 5 years
Other
c. Procedures
Within 1 week
Within 1 month
Within 3 months
Within 6 months
Within 1 year
Within 5 years
Other
d. Previously administered medications
Within 1 week
Within 1 month
Within 3 months
Within 6 months
Within 1 year
Within 5 years
Other
TOO MUCH DATA, NOT ENOUGH DATA 110
e. Radiographs
Within 1 week
Within 1 month
Within 3 months
Within 6 months
Within 1 year
Within 5 years
Other
f. Electrocardiograms
Within 1 week Within 1 month Within 3 months Within 6 months Within 1 year Within 5 years Other
g. Problem List
Within 1 year
Within 2 years
Within 5 years
Complete
Other
h. Discharge Summaries
Within 1 year
Within 2 years
Within 5 years
Complete
Other
8. What is your level of education?
AD □
ADN□
BS□
BSN □
Masters Prepared □
Clinical Area of Expertise ____________________________________
TOO MUCH DATA, NOT ENOUGH DATA 111
Appendix J
Electronic Data Relevance Survey – Inpatient
TOO MUCH DATA, NOT ENOUGH DATA 112
Inpatient Survey
Electronic Data Relevance Survey
With the advent of electronic health information exchange across health care systems, there are a
number of questions about the actual data and information that should be exchanged to provide
better coordination and improved patient care. These questions are as follows:
Very little research has been conducted on what types of data/information would be most
important to exchange and the format in which it should be reviewed.
Exchanging data or information across healthcare systems may introduce inconsistent
data. This results in the need to understand who should be expected to resolve such
inconsistencies.
There is limited understanding of the factors that might influence how trustworthy data or
information may be considered went sent from another healthcare system.
Responses to this survey will begin to address these issues. Please answer the following
questions.
Identification of Most Valuable Data When choosing which data or information to send from one institution to another, the question of
relevance becomes a priority. Although no regulations have been defined, legal precedence
indicates that a clinician is responsible for data/information exchanged by another health care
system. In addition there is a concern about overwhelming clinicians with too much
data/information that may not be relevant. Actual data/information to be exchanged (to provide
care coordination and the best care) is in question. It is important to understand out of all
existing data, what is most relevant when providing clinical care.
TOO MUCH DATA, NOT ENOUGH DATA 113
1. As a clinician treating admitted patients from another healthcare system in your
hospital you understand you could receive any or all /information from that system.
You already have immediate electronic access to your patients’ allergy, medication
and problem list. Please indicate what additional data/information would be
important for you to have in caring for your admitted patients.
First, check the boxes next to all data and information types that you think would be
important in treating critically ill patients and then all admitted patients.
Second, rank up to 5 data types you think would be MOST REVELANT for you to
have in treating your admitted patients, with “1” being the single most important
type of data/information and “5” being the fifth most important type of
data/information.
Data/Information Type Critically
Ill
Patients
All
Admitted
Patients
Priority
Advanced directives
Behavioral health history
Cognitive abilities
Diet history
Discharge summaries
Electrocardiogram images
Family history
Genome information
Growth records
Health maintenance information
Health insurance
Immunization history
Laboratory results
Medical devices
Mobility/falls risk
Operative summaries
Patient goals
Patient instructions
Pending tests and procedures
Procedure results –
invasive/noninvasive
Progress notes
Provider information and
telephone number
Physical activity
Plain radiographic images
Radiology Tests (report)
TOO MUCH DATA, NOT ENOUGH DATA 114
CT, endoscopy, nuclear
medicine
scan, MRI, ultrasound
Radiology Tests (images)
CT, endoscopy, nuclear
medicine
scan, MRI, ultrasound
Review of systems
Special needs
Social history
Vital signs
Other (please specify)
Presentation of Received Data
Data and information received from another health care system may be received electronically
by clinicians in the form of a single document or incorporated into the patient’s current
electronic medical record (EMR).
2. In your opinion, should /information received from another healthcare system be
displayed as a separate electronic document and/or as integrated data within the
patient’s current electronic medical record?
g. Received as a separate electronic document?
h. Received as integrated data within the patient’s current EMR?
i. Received as both a separate electronic document and as integrated data within the
patient’s current EMR?
TOO MUCH DATA, NOT ENOUGH DATA 115
Reconciliation of Received and Existing Data
If data/information sent from another healthcare system are integrated within the patient’s
current EMR, there may be a need to reconcile duplications, inconsistencies and contradictions.
Part of this reconciliation will be completed by the computer but human interaction/decision
making will likely be needed as well.
3. Do you think a clinician should be required to reconcile inconsistencies between
data/information received from another healthcare system and the current EMR for
a patient they are currently caring for?
a. Yes
b. No, reconciliation is not necessary.
c. Only as needed on a case by case basis.
4. If such reconciliation of data or information was required, who do you think should
complete the reconciliation?
a. The physician caring for the patient in the receiving institution.
b. The nurse caring for the patient in the receiving institution.
c. The first licensed care giver encountering the patient in the receiving institution.
d. Should be dependent on the data shared (examples would be: pharmacist
reconciling medications, physicians reconciling labs, problems or allergies, and
nursing reconciling patient goals).
e. Other___________________________
TOO MUCH DATA, NOT ENOUGH DATA 116
Trustworthiness of Data
5. How IMPORTANT would each of the following conditions be in deciding if you
trust the data/information received from another healthcare system?
a. The strength of a working relationship with the provider from an outside
healthcare system who ordered or performed the procedure or otherwise prepared
the information. Not Important Somewhat Important Neutral Important Very Important Don’t Know
b. The reputation of the healthcare organization sending the data. Not Important Somewhat Important Neutral Important Very Important Don’t Know
c. Trusting the integrity of the health data exchange. Not Important Somewhat Important Neutral Important Very Important Don’t Know
d. Knowing the type of provider who ordered or performed the procedure or
otherwise prepared the information (specialist vs. generalist). Not Important Somewhat Important Neutral Important Very Important Don’t Know
e. The complexity of the patient. Not Important Somewhat Important Neutral Important Very Important Don’t Know
f. I can repeat the test/procedure and the repeated test/procedure will again be
reimbursed. Not Important Somewhat Important Neutral Important Very Important Don’t Know
g. How well the data is organized in a reliable (i.e. is the format intuitive). Not Important Somewhat Important Neutral Important Very Important Don’t Know
h. I trust the completeness, timeliness and accuracy of the data? Not Important Somewhat Important Neutral Important Very Important Don’t Know
TOO MUCH DATA, NOT ENOUGH DATA 117
Useful Date Ranges of Data
6. When looking for electronic health information exchanged across health care
systems what is the general time limit, by category that data/information is useful.
a. Vital Signs
Within 1 week
Within 1 month
Within 3 months
Within 6 months
Within 1 year
Within 5 years
Other
b. Laboratory Results
Within 1 week
Within 1 month
Within 3 months
Within 6 months
Within 1 year
Within 5 years
Other
c. Procedures
Within 1 week
Within 1 month
Within 3 months
Within 6 months
Within 1 year
Within 5 years
Other
d. Previously administered medications
Within 1 week
Within 1 month
Within 3 months
Within 6 months
Within 1 year
Within 5 years
Other
TOO MUCH DATA, NOT ENOUGH DATA 118
e. Radiographs
Within 1 week
Within 1 month
Within 3 months
Within 6 months
Within 1 year
Within 5 years
Other
f. Electrocardiograms
Within 1 week Within 1 month Within 3 months Within 6 months Within 1 year Within 5 years Other
g. Problem List
Within 1 year
Within 2 years
Within 5 years
Complete
Other
h. Discharge Summaries
Within 1 year
Within 2 years
Within 5 years
Complete
Other
8. What is your profession?
Other
TOO MUCH DATA, NOT ENOUGH DATA 119
Appendix K
Electronic Data Relevance Survey – Primary Care
TOO MUCH DATA, NOT ENOUGH DATA 120
Primary Care Survey
Electronic Data Relevance Survey
With the advent of electronic health information exchange across health care systems, there are a
number of questions about the actual data and information that should be exchanged to provide
better coordination and improved patient care. These questions are as follows:
Very little research has been conducted on what types of data/information would be most
important to exchange and the format in which it should be reviewed.
Exchanging data or information across healthcare systems may introduce inconsistent
data. This results in the need to understand who should be expected to resolve such
inconsistencies.
There is limited understanding of the factors that might influence how trustworthy data or
information may be considered went sent from another healthcare system.
Responses to this survey will begin to address these issues. Please answer the following
questions.
Identification of Most Valuable Data When choosing which data or information to send from one institution to another, the question of
relevance becomes a priority. Although no regulations have been defined, legal precedence
indicates that a clinician is responsible for data/information exchanged by another health care
system. In addition there is a concern about overwhelming clinicians with too much
data/information that may not be relevant. Actual data /information to be exchanged (to provide
care coordination and the best care) are in question. It is important to understand out of all
existing data and information, what is most relevant when providing clinical care.
TOO MUCH DATA, NOT ENOUGH DATA 121
1. As a clinician treating ambulatory patients from another healthcare system in an
primary care setting you understand you could receive any or all data/information
from that system. You already have immediate electronic access to your patients’
allergy, medication and problem list. Please indicate what additional
data/information would be important for you to have in caring for your clinic
patients.
First, check the boxes next to all data and information types that you think would be
important in treating clinic patients.
Second, rank up to 5 data types you think would be MOST RELEVANT for you to
have in treating your clinic patients with “1” being the single most important type of
data and “5” being the fifth most important type of data/information.
Data/Information Type All
Clinic
Patients
Priority
Advanced directives
Behavioral health history
Cognitive abilities
Diet history
Discharge summaries
Electrocardiogram images
Family history
Genome information
Growth records
Health maintenance information
Health insurance
Immunization history
Laboratory results
Medical devices
Mobility/falls risk
Operative summaries
Patient goals
Patient instructions
Pending tests and procedures
Procedure results –
invasive/noninvasive
Progress notes
Provider information and telephone
number
Physical activity
Plain radiographic images
Radiology Tests (report)
TOO MUCH DATA, NOT ENOUGH DATA 122
CT, endoscopy, nuclear medicine
scan, MRI, ultrasound
Radiology Tests (images)
CT, endoscopy, nuclear medicine
scan, MRI, ultrasound
Review of systems
Special needs
Social history
Vital signs
Other (please specify)
Presentation of Received Data
Data and information received from another health care system may be received electronically
by clinicians in the form of a single document or incorporated into the patient’s current
electronic medical record (EMR).
2. In your opinion, should data/information received from another healthcare system
be displayed as a separate electronic document and/or as integrated data within the
patient’s current electronic medical record?
j. Received as a separate electronic document?
k. Received as integrated data within the patient’s current EMR?
l. Received as both a separate electronic document and as integrated data within the
patient’s current EMR?
Reconciliation of Received and Existing Data
TOO MUCH DATA, NOT ENOUGH DATA 123
If data/information sent from another healthcare system are integrated within the patient’s
current EMR, there may be a need to reconcile duplications, inconsistencies and contradictions.
Part of this reconciliation will be completed by the computer but human interaction/decision
making will likely be needed as well.
3. Do you think a clinician should be required to reconcile inconsistencies between
data/information received from another healthcare system and the current EMR for
a patient they are currently caring for?
a. Yes
b. No, reconciliation is not necessary.
c. Only as needed on a case by case basis.
4. If such reconciliation of data or information was required, who do you think should
complete the reconciliation?
a. The physician caring for the patient in the receiving institution.
b. The nurse caring for the patient in the receiving institution.
c. The first licensed care giver encountering the patient in the receiving institution.
d. Should be dependent on the data shared (examples would be: pharmacist
reconciling medications, physicians reconciling labs, problems or allergies, and
nursing reconciling patient goals).
e. Other___________________________
Trustworthiness of Data
TOO MUCH DATA, NOT ENOUGH DATA 124
5. How IMPORTANT would each of the following conditions be in deciding if you
trust the /information received from another healthcare system?
a. The strength of a working relationship with the provider from an outside
healthcare system who ordered or performed the procedure or otherwise prepared
the information. Not Important Somewhat Important Neutral Important Very Important Don’t Know
b. The reputation of the healthcare organization sending the data. Not Important Somewhat Important Neutral Important Very Important Don’t Know
c. Trusting the integrity of the health data exchange. Not Important Somewhat Important Neutral Important Very Important Don’t Know
d. Knowing the type of provider who ordered or performed the procedure or
otherwise prepared the information (specialist vs. generalist). Not Important Somewhat Important Neutral Important Very Important Don’t Know
e. The complexity of the patient. Not Important Somewhat Important Neutral Important Very Important Don’t Know
f. I can repeat the test/procedure and the repeated test/procedure will again be
reimbursed. Not Important Somewhat Important Neutral Important Very Important Don’t Know
g. How well the data is organized in a reliable (i.e. is the format intuitive). Not Important Somewhat Important Neutral Important Very Important Don’t Know
h. I trust the completeness, timeliness and accuracy of the data? Not Important Somewhat Important Neutral Important Very Important Don’t Know
Useful Date Ranges of Data
TOO MUCH DATA, NOT ENOUGH DATA 125
6. When looking for electronic health information exchanged across health care
systems what is the general time limit, by category that data/information is useful.
a. Vital Signs
Within 1 week
Within 1 month
Within 3 months
Within 6 months
Within 1 year
Within 5 years
Other
b. Laboratory Results
Within 1 week
Within 1 month
Within 3 months
Within 6 months
Within 1 year
Within 5 years
Other
c. Procedures
Within 1 week
Within 1 month
Within 3 months
Within 6 months
Within 1 year
Within 5 years
Other
d. Previously administered medications
Within 1 week
Within 1 month
Within 3 months
Within 6 months
Within 1 year
Within 5 years
Other
TOO MUCH DATA, NOT ENOUGH DATA 126
e. Radiographs
Within 1 week
Within 1 month
Within 3 months
Within 6 months
Within 1 year
Within 5 years
Other
f. Electrocardiograms
Within 1 week Within 1 month Within 3 months Within 6 months Within 1 year Within 5 years Other
g. Problem List
Within 1 year
Within 2 years
Within 5 years
Complete
Other
h. Discharge Summaries
Within 1 year
Within 2 years
Within 5 years
Complete
Other
8. What is your profession?
Other ____________________________________________
TOO MUCH DATA, NOT ENOUGH DATA 127
Appendix L
Electronic Data Relevance Survey – Electronic Copy
TOO MUCH DATA, NOT ENOUGH DATA 128
Electronic Survey
Electronic Data Relevance Survey
Welcome to the Electronic Data Relevance Survey. Thank you for taking some time to provide
your feedback.
With the advent of electronic health information exchange across healthcare systems, there are a
number of issues about the actual data and information that should be exchanged to provide
better coordination and improved patient care. These issues include the following:
Very little research has been conducted on what types of data and information would be
most relevant to exchange and the format in which they should be reviewed.
Exchanging data or information across healthcare systems may introduce inconsistent
results. This results in the need to understand who should be expected to resolve such
inconsistencies.
There is limited understanding of the factors that might influence how trustworthy data or
information may be considered to be when received from another healthcare system.
Responses to this survey will help begin to address these issues. Please answer the questions that
follow.
Identification of Most Relevant Data
When choosing which data or information to send from one institution to another, the question of
relevance becomes a priority. Although no regulations have been defined, legal precedence
indicates that a clinician is responsible for information exchanged by another healthcare system.
In addition there is a concern about overwhelming clinicians with too much information that may
not be relevant. Actual data or information to be exchanged (to provide care coordination and the
best care) are in question. It is important to understand out of all existing data and information,
what is most relevant when providing clinical care.
The figure below is intended to illustrate the idea of identifying the most relevant information to
share between healthcare systems.
TOO MUCH DATA, NOT ENOUGH DATA 129
1. If as a clinician treating patients in an emergency department, you could receive
data and information electronically from another healthcare system on those
patients who have received care there.
If you knew that you could have immediate electronic access to those patients’
allergy, medication and problem lists from the other healthcare system, please
indicate what additional data/information you think would be relevant for you to
have from that system in caring for those ED patients.
Data/Information Type All ED
Patients
Critical ED
Patients
only
No ED
Patients
Advanced directives
Behavioral health history
Cognitive abilities
Diet history
Discharge summaries
Electrocardiogram images
Family history
Genome information
Growth records
Health maintenance information
Health insurance
Immunization history
Laboratory results
Medical devices
Mobility/falls risk
Operative summaries
Patient goals
TOO MUCH DATA, NOT ENOUGH DATA 130
Patient instructions
Pending tests and procedures
Procedure results –
invasive/noninvasive
Progress notes
Provider information and telephone
number
Physical activity
Plain radiographic images
Radiology Tests - Reports
(CT, endoscopy, nuclear medicine
scan, MRI, ultrasound)
Radiology Tests - Images
(CT, endoscopy, nuclear medicine
scan, MRI, ultrasound)
Review of systems
Special needs
Social history
Vital signs
Other (please specify)
2. Again, if as a clinician in an emergency department you could receive data and
information electronically from another healthcare system on those patients who
have received care there.
Please rank up to 5 data/information types that you think would be MOST
RELEVANT for you to receive from that system in treating those ED patients, with
“1” being the single most important and “5” being the fifth most important type.
Data/Information Type Priority
Advanced directives
Behavioral health history
Cognitive abilities
Diet history
Discharge summaries
Electrocardiogram images
Family history
Genome information
Growth records
Health maintenance information
Health insurance
Immunization history
Laboratory results
TOO MUCH DATA, NOT ENOUGH DATA 131
Medical devices
Mobility/falls risk
Operative summaries
Patient goals
Patient instructions
Pending tests and procedures
Procedure results – invasive/noninvasive
Progress notes
Provider information and telephone number
Physical activity
Plain radiographic images
Radiology Tests - Reports
(CT, endoscopy, nuclear medicine
scan, MRI, ultrasound)
Radiology Tests - Images
(CT, endoscopy, nuclear medicine
scan, MRI, ultrasound)
Review of systems
Special needs
Social history
Vital signs
Other (please specify)
a. Comments?
Presentation of Received Data/Information
Data and information received from another healthcare system may be received electronically by
clinicians in the form of a single document or integrated into the patient’s current electronic
medical record (EMR).
TOO MUCH DATA, NOT ENOUGH DATA 132
3. In your opinion, should data/information received from another healthcare system be
displayed as a separate electronic document and/or as integrated data within the
patient’s current electronic medical record?
m. Received as a separate electronic document
n. Received as integrated data/information within the patient’s current EMR
o. Received as both a separate electronic document and as integrated data/information
within the patient’s current EMR
a. Comments?
Reconciliation of Received and Existing Data
If data/information sent from another healthcare system are integrated within the patient’s
current EMR, there may be a need to reconcile duplications, inconsistencies and contradictions
(See figure below). Part of this reconciliation will be completed by the computer but human
interaction/decision making will likely be needed as well.
4. Do you think a clinician should be required to reconcile inconsistencies between
data/information received from another healthcare system and the current EMR for a
patient they are currently caring for?
TOO MUCH DATA, NOT ENOUGH DATA 133
a. Yes
b. No, reconciliation is not necessary
c. Only as needed on a case by case basis
5. If such reconciliation of data or information were required, who do you think should
complete the reconciliation?
a. The physician caring for the patient in the receiving institution
b. The nurse caring for the patient in the receiving institution
c. The first licensed care giver encountering the patient in the receiving institution
d. Should be dependent on the data shared (examples would be: pharmacist reconciling
medications, physicians reconciling labs, problems or allergies, and nursing reconciling
patient goals)
e. Other___________________________
a. Comments?
Trusting & Relying on Exchanged Health Data/Information
6. How IMPORTANT would each of the following be in determining how much you
would trust and rely on the data/information received from another healthcare system
when treating one of your ED patients?
No
t at
all
Sli
gh
tly
So
mew
hat
Ver
y
Ex
trem
ely
Do
n’t
Kn
ow
The complexity of the patient being treated
The reputation of the healthcare system sending the
data/information.
The type of provider who ordered or performed the
procedure or otherwise prepared the information (specialist
vs. generalist)
The strength of a working relationship with the provider
from the outside healthcare system who ordered or
performed the procedure or otherwise prepared the
information
How complete the data/information appear to be
How accurate the data/information appear to be
The reliability of the process and tools for exchanging health
data/information with the outside healthcare system
How well the data/information received are organized or
presented (i.e., the extent to which the format is intuitive to
understand)
The timeliness in receiving the data/information
TOO MUCH DATA, NOT ENOUGH DATA 134
If you can repeat tests/procedures performed at the other
healthcare system and the repeated tests/procedures would
again be reimbursed
a. Comments?
Time Limits for Received Data
NOTE: The timeframes below are intended to reflect the amount of time from when the data/information
were originally created or generated within the other healthcare system (e.g., when the vital signs were
taken, when the discharge summary was written), not the time from when the patient arrives at your
hospital and when the data/information are sent and received there.
7. When receiving health data/information electronically from other healthcare systems,
what would be the general time limits within which you would find the following types
of data/information useful when treating your ED patients?
Within 1
week
Within
1 month
Within 3
months
Within 6
months
Within 1
year
Within
5 years
Within
patient’s
lifetime
Other
(specify
below)
Vital Signs
Laboratory Results
Procedures
Previously administered medications
Radiographs
Electrocardiograms
Problem List
Discharge Summaries
a. Comments?
Your Profession
Your answer to this question will help in categorizing your responses.
8. What is your profession?
Physician
Nurse Practitioner
Physician Assistant
Other ____________________________________________
TOO MUCH DATA, NOT ENOUGH DATA 135
Appendix M
Electronic Data Relevance Survey – Pediatrics
TOO MUCH DATA, NOT ENOUGH DATA 136
Pediatric Survey
Electronic Data Relevance Survey
With the advent of electronic health information exchange across health care systems, there are a
number of questions about the actual data and information that should be exchanged to provide
better coordination and improved patient care. These questions are as follows:
Very little research has been conducted on what types of data/information would be most
important to exchange and the format in which it should be reviewed.
Exchanging data or information across healthcare systems may introduce inconsistent
data. This results in the need to understand who should be expected to resolve such
inconsistencies.
There is limited understanding of the factors that might influence how trustworthy data or
information may be considered went sent from another healthcare system.
Responses to this survey will begin to address these issues. Please answer the following
questions.
Identification of Most Valuable Data When choosing which data or information to send from one institution to another, the question of
relevance becomes a priority. Although no regulations have been defined, legal precedence
indicates that a clinician is responsible for data/information exchanged by another health care
system. In addition there is a concern about overwhelming clinicians with too much information
that may not be relevant. Actual data/information to be exchanged (to provide care coordination
and the best care) is in question. It is important to understand out of all existing
data/information, what is most relevant when providing clinical care.
TOO MUCH DATA, NOT ENOUGH DATA 137
1. As a clinician treating pediatric patients from another healthcare system in an
inpatient setting, you understand you could receive any or all data/information from
that system. You already have immediate electronic access to your patients’ allergy,
medication and problem list. Please indicate what additional data/information
would be important for you to have in caring for your hospitalized pediatric
patients.
First, check the boxes next to all data and information types that you think would be
important in treating critically ill pediatric patients and then all hospitalized
pediatric patients.
Second, rank up to 5 data/information types you think would be MOST
REVELANT for you to have in treating your hospitalized pediatric patients, with
“1” being the single most important type of data/information and “5” being the fifth
most important type of data/information.
Data/Information Type Critical
Pediatric
Patients
All
Pediatric
Patients
Priority
Advanced directives
Behavioral health history
Cognitive abilities
Diet history
Discharge summaries
Electrocardiogram images
Family history
Genome information
Growth records
Health maintenance information
Health insurance
Immunization history
Laboratory results
Medical devices
Mobility/falls risk
Operative summaries
Patient goals
Patient instructions
Pending tests and procedures
Procedure results –
invasive/noninvasive
Progress notes
Provider information and
telephone number
Physical activity
Plain radiographic images
TOO MUCH DATA, NOT ENOUGH DATA 138
Radiology Tests (report)
CT, endoscopy, nuclear
medicine
scan, MRI, ultrasound
Radiology Tests (images)
CT, endoscopy, nuclear
medicine
scan, MRI, ultrasound
Review of systems
Special needs
Social history
Vital signs
Other (please specify)
Presentation of Received Data
Data and information received from another health care system may be received electronically
by clinicians in the form of a single document or incorporated into the patient’s current
electronic medical record (EMR).
2. In your opinion, should data/information received from another healthcare system
be displayed as a separate electronic document and/or as integrated
data/information within the patient’s current electronic medical record?
p. Received as a separate electronic document?
q. Received as integrated data within the patient’s current EMR?
r. Received as both a separate electronic document and as integrated data within the
patient’s current EMR?
Reconciliation of Received and Existing Data
TOO MUCH DATA, NOT ENOUGH DATA 139
If data/information sent from another healthcare system are integrated within the patient’s
current EMR, there may be a need to reconcile duplications, inconsistencies and contradictions.
Part of this reconciliation will be completed by the computer but human interaction/decision
making will likely be needed as well.
3. Do you think a clinician should be required to reconcile inconsistencies between
data/information received from another healthcare system and the current EMR for
a patient they are currently caring for?
a. Yes
b. No, reconciliation is not necessary.
c. Only as needed on a case by case basis.
4. If such reconciliation of data or information was required, who do you think should
complete the reconciliation?
a. The physician caring for the patient in the receiving institution.
b. The nurse caring for the patient in the receiving institution.
c. The first licensed care giver encountering the patient in the receiving institution.
d. Should be dependent on the data shared (examples would be: pharmacist
reconciling medications, physicians reconciling labs, problems or allergies, and
nursing reconciling patient goals).
e. Other___________________________
TOO MUCH DATA, NOT ENOUGH DATA 140
Trustworthiness of Data
5. How IMPORTANT would each of the following conditions be in deciding if you
trust the data/information received from another healthcare system?
a. The strength of a working relationship with the provider from an outside
healthcare system who ordered or performed the procedure or otherwise prepared
the information. Not Important Somewhat Important Neutral Important Very Important Don’t Know
b. The reputation of the healthcare organization sending the data. Not Important Somewhat Important Neutral Important Very Important Don’t Know
c. Trusting the integrity of the health data exchange. Not Important Somewhat Important Neutral Important Very Important Don’t Know
d. Knowing the type of provider who ordered or performed the procedure or
otherwise prepared the information (specialist vs. generalist). Not Important Somewhat Important Neutral Important Very Important Don’t Know
e. The complexity of the patient. Not Important Somewhat Important Neutral Important Very Important Don’t Know
f. I can repeat the test/procedure and the repeated test/procedure will again be
reimbursed. Not Important Somewhat Important Neutral Important Very Important Don’t Know
g. How well the data is organized in a reliable (i.e. is the format intuitive). Not Important Somewhat Important Neutral Important Very Important Don’t Know
h. I trust the completeness, timeliness and accuracy of the data? Not Important Somewhat Important Neutral Important Very Important Don’t Know
TOO MUCH DATA, NOT ENOUGH DATA 141
Useful Date Ranges of Data
6. When looking for electronic health information exchanged across health care
systems what is the general time limit, by category that data/information is useful.
7. Vital Signs
Within 1 week
Within 1 month
Within 3 months
Within 6 months
Within 1 year
Within 5 years
Other
8. Laboratory Results
Within 1 week
Within 1 month
Within 3 months
Within 6 months
Within 1 year
Within 5 years
Other
9. Procedures
Within 1 week
Within 1 month
Within 3 months
Within 6 months
Within 1 year
Within 5 years
Other
10. Previously administered medications
Within 1 week
Within 1 month
Within 3 months
Within 6 months
Within 1 year
Within 5 years
Other
TOO MUCH DATA, NOT ENOUGH DATA 142
11. Radiographs
Within 1 week
Within 1 month
Within 3 months
Within 6 months
Within 1 year
Within 5 years
Other
12. Electrocardiograms
Within 1 week Within 1 month Within 3 months Within 6 months Within 1 year Within 5 years Other
13. Problem List
Within 1 year
Within 2 years
Within 5 years
Complete
Other
14. Discharge Summaries
Within 1 year
Within 2 years
Within 5 years
Complete
Other
8. What is your profession?
Other ____________________________________________
TOO MUCH DATA, NOT ENOUGH DATA 143
Appendix N
Electronic Data Relevance Survey – Primary Care Nursing
TOO MUCH DATA, NOT ENOUGH DATA 144
Primary Care Nursing Survey
Electronic Data Relevance Survey
With the advent of electronic health information exchange across health care systems, there are a
number of questions about the actual data and information that should be exchanged to provide
better coordination and improved patient care. These questions are as follows:
Very little research has been conducted on what types of data/information would be most
important to exchange and the format in which it should be reviewed.
Exchanging data or information across healthcare systems may introduce inconsistent
data. This results in the need to understand who should be expected to resolve such
inconsistencies.
There is limited understanding of the factors that might influence how trustworthy data or
information may be considered went sent from another healthcare system.
Responses to this survey will begin to address these issues. Please answer the following
questions.
Identification of Most Valuable Data When choosing which data or information to send from one institution to another, the question of
relevance becomes a priority. Although no regulations have been defined, legal precedence
indicates that a clinician is responsible for information exchanged by another health care system.
In addition there is a concern about overwhelming clinicians with too much data/information that
may not be relevant. Actual data/information to be exchanged (to provide care coordination and
the best care) is in question. It is important to understand out of all existing data/information,
what is most relevant when providing clinical care.
TOO MUCH DATA, NOT ENOUGH DATA 145
4. As a clinician caring for patients from another healthcare system in an ambulatory
setting you understand you could receive any or all data/information from that
system. You already have immediate electronic access to your patients’ allergy,
medication and problem list. Please indicate what additional data/information
would be important for you to have in caring for your ambulatory patients.
First, check the boxes next to all data and information types that you think would be
important in treating patients in an ambulatory setting.
Second, rank up to 5 data/information types you think would be MOST
REVELANT for you to have in treating your ambulatory patients with “1” being
the single most important type of data/information and “5” being the fifth most
important type of data/information.
Data/Information Type All
Clinic
Patients
Priority
Advanced directives
Behavioral health history
Cognitive abilities
Diet history
Discharge summaries
Electrocardiogram images
Family history
Genome information
Growth records
Health maintenance information
Health insurance
Immunization history
Laboratory results
Medical devices
Mobility/falls risk
Operative summaries
Patient goals
Patient instructions
Pending tests and procedures
Procedure results –
invasive/noninvasive
Progress notes
Provider information and telephone
number
Physical activity
Plain radiographic images
TOO MUCH DATA, NOT ENOUGH DATA 146
Radiology Tests (report)
CT, endoscopy, nuclear medicine
scan, MRI, ultrasound
Radiology Tests (images)
CT, endoscopy, nuclear medicine
scan, MRI, ultrasound
Review of systems
Special needs
Social history
Vital signs
Other (please specify)
Presentation of Received Data
Data and information received from another health care system may be received electronically
by clinicians in the form of a single document or incorporated into the patient’s current
electronic medical record (EMR).
1 In your opinion, should data/information received from another healthcare system
be displayed as a separate electronic document and/or as integrated data within the
patient’s current electronic medical record?
s. Received as a separate electronic document?
t. Received as integrated data within the patient’s current EMR?
u. Received as both a separate electronic document and as integrated data within the
patient’s current EMR?
Reconciliation of Received and Existing Data
If data/information sent from another healthcare system is integrated within the patient’s current
EMR, there may be a need to reconcile duplications, inconsistencies and contradictions. Part of
TOO MUCH DATA, NOT ENOUGH DATA 147
this reconciliation will be completed by the computer but human interaction/decision making
will likely be needed as well.
2 Do you think a clinician should be required to reconcile inconsistencies between
data/information received from another healthcare system and the current EMR for
a patient they are currently caring for?
a. Yes
b. No, reconciliation is not necessary.
c. Only as needed on a case by case basis.
3 If such reconciliation of data or information was required, who do you think should
complete the reconciliation?
a. The physician caring for the patient in the receiving institution.
b. The nurse caring for the patient in the receiving institution.
c. The first licensed care giver encountering the patient in the receiving institution.
d. Should be dependent on the data shared (examples would be: pharmacist
reconciling medications, physicians reconciling labs, problems or allergies, and
nursing reconciling patient goals).
e. Other___________________________
Trustworthiness of Data
TOO MUCH DATA, NOT ENOUGH DATA 148
4 How IMPORTANT would each of the following conditions be in deciding if you
trust the data/information received from another healthcare system?
a. The strength of a working relationship with the provider from an outside
healthcare system who ordered or performed the procedure or otherwise prepared
the information. Not Important Somewhat Important Neutral Important Very Important Don’t Know
b. The reputation of the healthcare organization sending the data. Not Important Somewhat Important Neutral Important Very Important Don’t Know
c. Trusting the integrity of the health data exchange. Not Important Somewhat Important Neutral Important Very Important Don’t Know
d. Knowing the type of provider who ordered or performed the procedure or
otherwise prepared the information (specialist vs. generalist). Not Important Somewhat Important Neutral Important Very Important Don’t Know
e. The complexity of the patient. Not Important Somewhat Important Neutral Important Very Important Don’t Know
f. I can repeat the test/procedure and the repeated test/procedure will again be
reimbursed. Not Important Somewhat Important Neutral Important Very Important Don’t Know
g. How well the data is organized in a reliable (i.e. is the format intuitive). Not Important Somewhat Important Neutral Important Very Important Don’t Know
h. I trust the completeness, timeliness and accuracy of the data? Not Important Somewhat Important Neutral Important Very Important Don’t Know
Useful Date Ranges of Data
TOO MUCH DATA, NOT ENOUGH DATA 149
5 When looking for electronic health information exchanged across health care
systems what is the general time limit, by category that data/information is useful.
15. Vital Signs
Within 1 week
Within 1 month
Within 3 months
Within 6 months
Within 1 year
Within 5 years
Other
16. Laboratory Results
Within 1 week
Within 1 month
Within 3 months
Within 6 months
Within 1 year
Within 5 years
Other
17. Procedures
Within 1 week
Within 1 month
Within 3 months
Within 6 months
Within 1 year
Within 5 years
Other
18. Previously administered medications
Within 1 week
Within 1 month
Within 3 months
Within 6 months
Within 1 year
Within 5 years
Other
TOO MUCH DATA, NOT ENOUGH DATA 150
19. Radiographs
Within 1 week
Within 1 month
Within 3 months
Within 6 months
Within 1 year
Within 5 years
Other
20. Electrocardiograms
Within 1 week Within 1 month Within 3 months Within 6 months Within 1 year Within 5 years Other
21. Problem List
Within 1 year
Within 2 years
Within 5 years
Complete
Other
22. Discharge Summaries
Within 1 year
Within 2 years
Within 5 years
Complete
Other
8. What is your level of education?
AD □
ADN□
BS□
BSN □
Masters Prepared □
Clinical Area of Expertise ____________________________________
TOO MUCH DATA, NOT ENOUGH DATA 151
Appendix O
Relevant Data by Specialty
TOO MUCH DATA, NOT ENOUGH DATA 152
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%D
isch
arge
sum
mar
ies
Imm
un
izat
ion
his
tory
Lab
ora
tory
res
ult
s
Rad
iolo
gy T
ests
- R
eport
s (C
T,…
Pro
vid
er i
nfo
rmat
ion a
nd t
elep
hone…
Pla
in r
adio
gra
phic
im
ages
Gro
wth
rec
ord
s
Pro
cedure
res
ult
s –
…
Rad
iolo
gy T
ests
- I
mag
es (
CT
,…
Oper
ativ
e su
mm
arie
s
Die
t his
tory
Pen
din
g t
ests
and p
roce
dure
s
Pro
gre
ss n
ote
s
Beh
avio
ral
hea
lth h
isto
ry
Fam
ily h
isto
ry
Soci
al h
isto
ry
Advan
ced d
irec
tives
Ele
ctro
card
iogra
m i
mag
es
Med
ical
dev
ices
Cognit
ive
abil
itie
s
Physi
cal
acti
vit
y
Rev
iew
of
syst
ems
Spec
ial
nee
ds
Vit
al s
igns
Hea
lth m
ainte
nan
ce i
nfo
rmat
ion
Mobil
ity/f
alls
ris
k
Pat
ient
goal
s
Hea
lth i
nsu
rance
Pat
ient
inst
ruct
ions
Gen
om
e in
form
atio
n
Relevant Data
Pediatric
Percent
TOO MUCH DATA, NOT ENOUGH DATA 153
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Lab
ora
tory
res
ult
s
Rad
iolo
gy T
ests
- R
eport
s
Dis
char
ge
sum
mar
ies
Advan
ced d
irec
tives
Pro
vid
er i
nfo
rmat
ion
and…
Med
ical
dev
ices
Vit
al s
igns
Pro
cedure
res
ult
s – …
Oper
ativ
e su
mm
arie
s
Rad
iolo
gy T
ests
- I
mag
es
Ele
ctro
card
iogra
m i
mag
es
Pla
in r
adio
gra
phic
im
ages
Pro
gre
ss n
ote
s
Beh
avio
ral
hea
lth h
isto
ry
Hea
lth i
nsu
rance
Imm
uniz
atio
n h
isto
ry
Pen
din
g t
ests
and p
roce
dure
s
Soci
al h
isto
ry
Fam
ily h
isto
ry
Hea
lth m
ainte
nan
ce i
nfo
rmat
ion
Cognit
ive
abil
itie
s
Pat
ient
goal
s
Spec
ial
nee
ds
Mobil
ity/f
alls
ris
k
Rev
iew
of
syst
ems
Gen
om
e in
form
atio
n
Physi
cal
acti
vit
y
Die
t his
tory
Gro
wth
rec
ord
s
Pat
ient
inst
ruct
ion
s
Relevant Data
Inpatient LIP
TOO MUCH DATA, NOT ENOUGH DATA 154
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Oper
ativ
e su
mm
arie
s
Pro
cedure
res
ult
s –
…
Pla
in r
adio
gra
phic
im
ages
Rad
iolo
gy T
ests
- R
eport
s (C
T,…
Vit
al s
igns
Ele
ctro
card
iogra
m i
mag
es
Imm
uniz
atio
n h
isto
ry
Pro
vid
er i
nfo
rmat
ion a
nd…
Fam
ily h
isto
ry
Lab
ora
tory
res
ult
s
Med
ical
dev
ices
Pro
gre
ss n
ote
s
Rad
iolo
gy T
ests
- I
mag
es (
CT
,…
Dis
char
ge
sum
mar
ies
Soci
al h
isto
ry
Beh
avio
ral
hea
lth h
isto
ry
Spec
ial
nee
ds
Advan
ced d
irec
tives
Pen
din
g t
ests
and p
roce
dure
s
Mobil
ity/f
alls
ris
k
Rev
iew
of
syst
ems
Gro
wth
rec
ord
s
Hea
lth i
nsu
rance
Cognit
ive
abil
itie
s
Hea
lth m
ainte
nan
ce i
nfo
rmat
ion
Pat
ient
inst
ruct
ions
Gen
om
e in
form
atio
n
Pat
ien
t goal
s
Physi
cal
acti
vit
y
Die
t his
tory
Relevant Data
ED LIP
TOO MUCH DATA, NOT ENOUGH DATA 155
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Dis
char
ge
sum
mar
ies
Lab
ora
tory
res
ult
s
Rad
iolo
gy T
ests
- R
eport
s (C
T,…
Med
ical
dev
ices
Advan
ced d
irec
tives
Pro
cedure
res
ult
s – …
Oper
ativ
e su
mm
arie
s
Imm
uniz
atio
n h
isto
ry
Hea
lth m
ainte
nan
ce i
nfo
rmat
ion
Ele
ctro
card
iogra
m i
mag
es
Vit
al s
igns
Beh
avio
ral
hea
lth h
isto
ry
Cognit
ive
abil
itie
s
Gro
wth
rec
ord
s
Pen
din
g t
ests
and p
roce
dure
s
Rad
iolo
gy T
ests
- I
mag
es (
CT
,…
Pro
gre
ss n
ote
s
Pro
vid
er i
nfo
rmat
ion a
nd…
Fam
ily h
isto
ry
Soci
al h
isto
ry
Pla
in r
adio
gra
phic
im
ages
Spec
ial
nee
ds
Rev
iew
of
syst
ems
Gen
om
e in
form
atio
n
Hea
lth i
nsu
rance
Pat
ient
goal
s
Pat
ient
inst
ruct
ion
s
Mobil
ity/f
alls
ris
k
Physi
cal
acti
vit
y
Die
t his
tory
Relevant Data
Outpatient LIP
TOO MUCH DATA, NOT ENOUGH DATA 156
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Lab
ora
tory
res
ult
s
Advan
ced d
irec
tives
Pro
cedure
res
ult
s – …
Imm
uniz
atio
n h
isto
ry
Spec
ial
nee
ds
Med
ical
dev
ices
Pen
din
g t
ests
and p
roce
dure
s
Pro
gre
ss n
ote
s
Rad
iolo
gy T
ests
- R
eport
s (C
T,…
Mobil
ity/f
alls
ris
k
Pro
vid
er i
nfo
rmat
ion a
nd…
Hea
lth i
nsu
rance
Dis
char
ge
sum
mar
ies
Oper
ativ
e su
mm
arie
s
Rad
iolo
gy T
ests
- I
mag
es (
CT
,…
Soci
al h
isto
ry
Beh
avio
ral
hea
lth h
isto
ry
Vit
al s
igns
Cognit
ive
abil
itie
s
Ele
ctro
card
iogra
m i
mag
es
Fam
ily h
isto
ry
Pla
in r
adio
gra
phic
im
ages
Rev
iew
of
syst
ems
Die
t his
tory
Physi
cal
acti
vit
y
Pat
ient
inst
ruct
ions
Hea
lth m
ainte
nan
ce i
nfo
rmat
ion
Pat
ient
goal
s
Gen
om
e in
form
atio
n
Gro
wth
rec
ord
s
Relevant Data
Inpatient Nursing
TOO MUCH DATA, NOT ENOUGH DATA 157
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Dis
char
ge
sum
mar
ies
Fam
ily h
isto
ry
Lab
ora
tory
res
ult
s
Oper
ativ
e su
mm
arie
s
Pro
gre
ss n
ote
s
Vit
al s
igns
Pro
cedure
res
ult
s – …
Hea
lth i
nsu
rance
Rad
iolo
gy T
ests
- R
eport
s (C
T,…
Spec
ial
nee
ds
Pro
vid
er i
nfo
rmat
ion a
nd t
elep
hone…
Rev
iew
of
syst
ems
Advan
ced d
irec
tives
Beh
avio
ral
hea
lth h
isto
ry
Imm
uniz
atio
n h
isto
ry
Cognit
ive
abil
itie
s
Med
ical
dev
ices
Mob
ilit
y/f
alls
ris
k
Pat
ient
inst
ruct
ions
Pen
din
g t
ests
and p
roce
dure
s
Physi
cal
acti
vit
y
Pla
in r
adio
gra
phic
im
ages
Soci
al h
isto
ry
Die
t his
tory
Ele
ctro
card
iogra
m i
mag
es
Gro
wth
rec
ord
s
Hea
lth m
ainte
nan
ce i
nfo
rmat
ion
Rad
iolo
gy T
ests
- I
mag
es (
CT
,…
Pat
ient
goal
s
Gen
om
e in
form
atio
n
Relevant Data
Outpatient Nursing
TOO MUCH DATA, NOT ENOUGH DATA 158
Appendix P
Relevant Emergent Data
TOO MUCH DATA, NOT ENOUGH DATA 159
0%
5%
10%
15%
20%
25%
30%
Ele
ctro
card
iogra
m i
mag
es
Advan
ced d
irec
tives
Oper
ativ
e su
mm
arie
s
Pro
gre
ss n
ote
s
Rad
iolo
gy T
ests
- I
mag
es (
CT
,…
Beh
avio
ral
hea
lth h
isto
ry
Die
t his
tory
Hea
lth m
ainte
nan
ce i
nfo
rmat
ion
Pla
in r
adio
gra
phic
im
ages
Rad
iolo
gy T
ests
- R
eport
s (C
T,…
Cognit
ive
abil
itie
s
Pat
ient
goal
s
Pen
din
g t
ests
and p
roce
dure
s
Dis
char
ge
sum
mar
ies
Imm
uniz
atio
n h
isto
ry
Med
ical
dev
ices
Mobil
ity/f
alls
ris
k
Vit
al s
igns
Gen
om
e in
form
atio
n
Hea
lth i
nsu
rance
Lab
ora
tory
res
ult
s
Pat
ient
inst
ruct
ions
Pro
cedure
res
ult
s – …
Pro
vid
er i
nfo
rmat
ion a
nd…
Physi
cal
acti
vit
y
Spec
ial
nee
ds
Fam
ily h
isto
ry
Gro
wth
rec
ord
s
Rev
iew
of
syst
ems
Soci
al h
isto
ry
Emergent Data
Inpatient LIP
TOO MUCH DATA, NOT ENOUGH DATA 160
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Advan
ced d
irec
tives
Dis
char
ge
sum
mar
ies
Lab
ora
tory
res
ult
s
Rad
iolo
gy T
ests
- R
eport
s (C
T,…
Vit
al s
igns
Pro
cedure
res
ult
s – …
Pla
in r
adio
gra
phic
im
ages
Oper
ativ
e su
mm
arie
s
Pro
gre
ss n
ote
s
Ele
ctro
card
iogra
m i
mag
es
Imm
uniz
atio
n h
isto
ry
Pro
vid
er i
nfo
rmat
ion a
nd…
Med
ical
dev
ices
Rad
iolo
gy T
ests
- I
mag
es (
CT
,…
Pen
din
g t
ests
and p
roce
dure
s
Gro
wth
rec
ord
s
Fam
ily h
isto
ry
Die
t his
tory
Cognit
ive
abil
itie
s
Mobil
ity/f
alls
ris
k
Spec
ial
nee
ds
Soci
al h
isto
ry
Beh
avio
ral
hea
lth
his
tory
Gen
om
e in
form
atio
n
Hea
lth m
ainte
nan
ce i
nfo
rmat
ion
Hea
lth i
nsu
rance
Pat
ient
goal
s
Pat
ient
inst
ruct
ions
Physi
cal
acti
vit
y
Rev
iew
of
syst
ems
Emergent Data
Pediatric LIP
TOO MUCH DATA, NOT ENOUGH DATA 161
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Advan
ced d
irec
tives
Rad
iolo
gy T
ests
- I
mag
es (
CT
,…
Beh
avio
ral
hea
lth h
isto
ry
Cognit
ive
abil
itie
s
Dis
char
ge
sum
mar
ies
Ele
ctro
card
iogra
m i
mag
es
Pro
vid
er i
nfo
rmat
ion a
nd…
Die
t his
tory
Fam
ily h
isto
ry
Gro
wth
rec
ord
s
Lab
ora
tory
res
ult
s
Mobil
ity/f
alls
ris
k
Oper
ativ
e su
mm
arie
s
Pro
cedure
res
ult
s – …
Pro
gre
ss n
ote
s
Pla
in r
adio
gra
phic
im
ages
Rad
iolo
gy T
ests
- R
eport
s (C
T,…
Rev
iew
of
syst
ems
Spec
ial
nee
ds
Gen
om
e in
form
atio
n
Hea
lth m
ainte
nan
ce i
nfo
rmat
ion
Hea
lth i
nsu
rance
Imm
un
izat
ion
his
tory
Med
ical
dev
ices
Pat
ient
go
als
Pat
ient
inst
ruct
ions
Pen
din
g t
ests
and p
roce
dure
s
Physi
cal
acti
vit
y
Soci
al h
isto
ry
Vit
al s
igns
Emergent Data
ED LIP
TOO MUCH DATA, NOT ENOUGH DATA 162
0%
5%
10%
15%
20%
25%
30%
35%
Ele
ctro
card
iogra
m i
mag
es
Rev
iew
of
syst
ems
Oper
ativ
e su
mm
arie
s
Dis
char
ge
sum
mar
ies
Rad
iolo
gy T
ests
- R
eport
s (C
T,…
Rad
iolo
gy T
ests
- I
mag
es (
CT
,…
Pla
in r
adio
gra
phic
im
ages
Pen
din
g t
ests
and p
roce
dure
s
Pro
gre
ss n
ote
s
Vit
al s
igns
Advan
ced d
irec
tives
Cognit
ive
abil
itie
s
Die
t his
tory
Fam
ily h
isto
ry
Pro
vid
er i
nfo
rmat
ion a
nd…
Spec
ial
nee
ds
Hea
lth m
ainte
nan
ce i
nfo
rmat
ion
Imm
uniz
atio
n h
isto
ry
Med
ical
dev
ices
Pro
cedure
res
ult
s –
…
Phy
sica
l ac
tivit
y
Lab
ora
tory
res
ult
s
Gro
wth
rec
ord
s
Beh
avio
ral
hea
lth h
isto
ry
Pat
ient
goal
s
Soci
al h
isto
ry
Gen
om
e in
form
atio
n
Pat
ient
inst
ruct
ions
Mobil
ity/f
alls
ris
k
Hea
lth i
nsu
ran
ce
Emergent Data
Inpatient Nursing
TOO MUCH DATA, NOT ENOUGH DATA 163
Appendix Q
Presentation of Exchanged Data – Separate or Integrated