Coordinating shared care using electronic data interchange.

Shared care is the situation in which physicians jointly treat the same patient. Shared care may occur with elderly patients suffering from several health problems, patients with chronic disorders such as diabetes, mellitus, obstructive pulmonary diseases, or cardiological disorders. For a number of health problems, including diabetes, shared care protocols have been developed involving division of tasks between health care providers from different disciplines [1]. Optimal communication is considered to be a vital aspect of shared care, both from medical and cost-effectiveness points of view, but at the same time communication forms the bottleneck as physicians often lack time to comply with the protocol [2]. At present, new technologies are emerging that hold the promise of improving communication between health care providers. One such technology is Electronic Data Interchange (EDI), defined as "the replacement of paper documents by standard electronic messages conveyed from one computer to another without manual intervention" [3]. In Europe, the ISO syntax standard EDIFACT has been adopted as the standard for defining EDI-messages [4]. In The Netherlands, coordination of the standardization of health care messages is performed by a national organization. At present, several standardized messages are available for a variety of purposes. One is a message for data exchange between physicians; in this message, however, only physician-patient- and hospital-identifying data are structured, and all medical data is transferred as free text. Consequently, using this message, the receiving system is unable to integrate the data into the computer-based patient record. In order to support shared care, a message is needed that can also transfer the structure of the data in a computer-based record in order to allow integration of records from multiple sources. Therefore, we developed a new message, called MEDEUR, that is designed for integrated patient data exchange between computer-based patient records. The message can contain both administrative and medical data and can be used for transmission of a complete medical record, or sections of it. Our departments are working on a project in which general practitioners and specialists use their own electronic medical record system for storing data of jointly treated patients. In addition, the participating physicians use the MEDEUR message standard in communicating about these patients. The use of EDI enables physicians to transmit patient data electronically to another physician's computer system. The receiving physician can store the data automatically in his electronic medical record without having to re-type the data. We will demonstrate the electronic data interchange functionality of the general practitioner's information system, ELIAS, and the integrated composing and storing of electronic messages. We will also discuss several system design issues.