Why it’s possible to make interoperability happen now

As a child raised in a military family, I vividly remember my mother carrying our family’s medical records around in a cardboard box each time we moved across the country. My father, Master Sargent Charles Miller, was a 22-year Air Force veteran, and I am the oldest of his six children.

Moving around so much meant that having an up-to-date vaccination record was an important part of starting in any new school. I recall travelling from Randolph Air Force Base in San Antonio, to Edwards Air Force Base in California, in a Rambler station wagon with my siblings, a dog, and all of our medical records in that cardboard box on the floorboard.

That experience helped guide me to where I am today, leading the effort at Children’s Health System of Texas to ensure patients’ care journey includes the seamless exchange of their important health care data.



Since Children’s Health first started exchanging records in 2010, we’ve connected with over 660 organizations, representing thousands of facilities, in all 50 states. In total, we’ve exchanged 8.4 million patient records. We use Epic’s comprehensive health record software, which can exchange with organizations regardless of what software they use. In fact, nearly half of the organizations we’ve exchanged with use a different electronic health record system.

I recently presented at Epic’s Un-Users Group Meeting, a forum for provider organizations who don’t use Epic, where they learned how to interoperate, and I left feeling optimistic that more providers are learning how to use available technology to connect. Sick kids don’t only come to us from other Epic hospitals, so this vendor-agnostic exchange is crucial for better quality and continuity of care.

Our journey toward frictionless record exchange began eight years ago, when I started calling around to other hospitals here in Dallas to see who would partner with us for a pilot. I was met with lots of concern about legality and privacy, but finally Texas Health Resources agreed to give it a try. We successfully set up the connection and exchanged a patient record, a first for both of our organizations.

Our exchanges have increased dramatically since then—so far this year, we’ve exchanged more than 200,000 records with Texas Health Resources using Care Everywhere.

In 2012, we started sharing records with the Social Security Administration via the eHealth Exchange, which now spans all 50 states. This was an important connection because we care for hundreds of kids who receive disability benefits. Providing parents with the peace of mind that their child’s care will be covered is something we strive for.

The time to get SSA disability benefits approval has decreased by from weeks to days. With 14 military bases in Texas, the ability to connect with the Department of Defense is crucial. Our connectivity with the eHealth Exchange also makes that possible as we exchange records for children of service members, and last year we exchanged more than 1,600 records with the DoD.

Joining Carequality was the next logical step for us to continue to expand our reach and connect with more organizations. Their standardized, national-level network was not only easy to plug into, but it gave us immediate access to more than 600,000 providers nationwide who are using a variety of EHR systems.

Thanks to that broad reach, we’ve been able to retrieve nearly 350,000 patient records with clinical documents via the SureScripts Record Locator and Exchange. Now, we can connect to other organizations that are part of the Carequality framework in a matter of hours rather than deliberating for months with individual health care systems about the terms of the exchange. Recently, CommonWell announced that it has established a connection to Carequality, joining the other vendors who support this valuable framework. I am hopeful that CommonWell will continue to broaden their support, expanding the number of organizations we can connect with.

We still have work to do here at Children’s Health to make accessing a patient’s full story easy for providers. We’re working to take advantage of Happy Together, part of Epic’s design philosophy that aims to create One Virtual System Worldwide. Not only will providers have access to patients’ information, it’ll appear as one view on their screen, without having to open separate documents to review health history from other organizations. They’ll be able to see a patient’s full longitudinal plan of care and exchange reference-quality images.

There are easy and actionable steps—like joining Carequality—which every organization can take today to share data and improve patient care. When we all adopt a common language and governance structure for exchanging patient information, true interoperability between any health care organizations using electronic health records is possible. The technology is already here – patients and families no longer must rely on a cardboard box to assure health care continuity.