Health Experts Make Health Information Exchange for Poison Control

A poison control center (PCC) is vital to patient care, especially when dealing with the opioid epidemic. However, health information exchange (HIE) software and infrastructure at PCCs are largely inconsistent and mostly nonexistent.

To combat that, researchers at University of Utah, the Utah Health Information Network (UHIN), and Intermountain Healthcare successfully implemented and launched a standards-based HIE at the Utah PCC, the group said in a recent JAMIA article.

According to the Centers or Disease Control & Prevention (CDC), poisonings, primarily from drug overdoses, are the leading cause of unintentional death and injury in the United States. This statistic has climbed over the past 22 decades.

In 2017 alone, PCCs tallied more than 650,000 cases of unintentional poisoning and drug overdoses, and the CDC reported over 70,000 drug overdose deaths.

PCCs, which are largely publicly funded call centers operated by registered nurses and pharmacists, play an important role in emergency treatment and poison exposure surveillance.

Since 31 percent of the patients who call are forwarded to a healthcare facility, such as an emergency department, the PCC is somewhat of a middleman between the patient and provider, providing health information and recommendations for poison treatment.

“While PCC consultation is essential to quality care, the current process of ED–PCC collaboration is highly dependent upon synchronous and asynchronous telephone communication resulting in workflow interruption for the ED, poor data quality and capture, and unreliable processes for sharing information among team members who are caring for the patient,” wrote the study authors.

“In prior work, we studied the typical telephone-based communication process and found a number of inefficiencies and safety vulnerabilities in the ED–PCC collaboration process.”

In order to enable PCC participation in a standards-based HIE, researchers in Utah needed to leverage existing exchange networks, such as UHIN, to enhance participation agreements between the Utah PCC and Intermountain Healthcare, the state’s largest health delivery system.

Prior to 2017, the PCC’s software was not compliant with HIE standards due to a lack of informatics tools and HIE integration processes, explained the authors. Because of this, there was no patient data exchange between Utah PCC and external health organizations.

For the PCC use case, researchers examined and adapted the HL7 Consolidated Clinical Document Architecture (C-CDA) consultation note. They then used rapid prototyping to develop and implement an HIE dashboard for the PCC employees to utilize. The team then developed the SNOWHITE software that enabled the HIE with a poisoning information system.

After researchers implemented SNOWHITE at the Utah PCC in early 2017, the PCC sent outbound C-CDA from the HIE dashboard. Then in late 2018, the PCC successfully received inbound C-CDA.

Patient data exchange and interoperability will always be under the microscope. But this is particularly true among PCCs that need to make rapid decisions. Since poisoned patients are quickly moved to EDs and care providers, PCCs should have patient data available to them within the workflow. Yet, this is not always the case.

“By developing short-term and long-term processes for exchanging poisoning-related information, we make poisoning-related information move in support of patient care,” wrote the authors. “By moving data with the patient to support care transitions and ongoing collaborative care, we shift the focus of information management from provider to patient.”

Quick and educated decisions cannot be made instantaneously if the data cannot be accessed by the PCC. Data needs to be complete, relevant, and accurate at all times in order for providers to make informed decisions at the point of care. Enhanced interoperability between PCCs and external health organizations allows for data access to be available in the workflow.

“By addressing information availability and workflow integration, we can ensure that exchanged data also matters,” the authors concluded. “This shift from unshared, provider-centric data to patient-centered information exchange is critically important for the management of poison exposures, but relevant to all provider-to-provider care transitions and collaborations.”