EHR Adoption Before Interoperability: Reflecting from 2009-2015

August 27th, 2015 /
Chris Ferguson
/ 9 Min Read

The Electronic Health Record industry 2015: many more medical practices use certified EHRs than did six years ago, which begs the question: “why isn’t there a Superhighway of Health Information Exchange.” According to many governmental agencies, such as the Office of the National Coordinator for Health Information Technology (ONC), only 54 percent of all office-based physicians have demonstrated meaningful use of certified health IT, as of April 2015.

Deductively, 46 percent of office based physicians are still not fully compliant according to this latest report. There are many different agencies offering a variety of EHR adoption statistics. The definition of EHR adoption also varies by agency. Terms such as EHR adoption, partially adopted EHR, fully functioning EHR and of course Meaningful Use compliant, are abundant. Interoperability technologies are ready today but there is not enough of a push from medical practices and hospitals to open the port of information flow. Private source code is still held close to the vest of EHR vendors.

HL7 is a communication protocol with capabilities for transfer of secure information between EHR companies through matrix design. HL7 is an ANSI-accredited framework focused on the standards of information exchange while protecting the EHR’s integrity. This widely recognized platform will allow different systems to communicate with one another. In addition,  two standards have evolved and are now available for interoperability.

Continuity of Care Record (CCR), is an electronic summary of a patient’s health record in an effort to reduce the risk of medical errors by making information available at the point of care.

Continuity of Care Document (CCD) is an electronic document exchange standard for sharing patient summary of this healthcare information. Summaries include some of the most commonly needed information about current and past health status in a form that can be shared by all computer applications. This information exchange can save patients’ lives. Properly communicating EHRs deliver these timely data points.

The United States healthcare industry is currently and seemingly continuously in great disarray, and has been undergoing change for decades. There is a new, but long discussed hurdle on the horizon: October 1, 2015, when the US Healthcare market will finally make the transition from ICD-9 to ICD-10. Many questions – from healthcare reform to the American Reinvestment and Recovery Act (ARRA) and stimulus dollars – have been answered. The ARRA triggered a more rapid rate of adoption of EHRs by practicing physicians in the US. However, most of the Electronic Health Record companies still do not have a viable plan or path to allow for communication between one EHR to another.

A true defined infrastructure of EHR interoperability is still not in place. There are no set standards in place as of 2015. Standards are being written and rewritten for enabling interoperability and information exchange between healthcare applications like EHR, practice management systems, and labs. This is a great plan; however, a more complete adoption of EHR must precede this “Superhighway Infrastructure.” EMR software is the single largest application that will provide the majority of healthcare information traffic on this superhighway. A superhighway with no traffic is of no value. Healthcare information traffic in a “traffic jam” of necessity will create the market and the much wider adoption of EHRs holds the keys to interoperability. Patient safety and need of medical history in rapid requirement will push a sustained interoperability to reality.  A certified EHR solution must be in place at the point of care before the industry can take the next step and be linked for information exchange. As noted, office based physicians still demonstrate 46% noncompliance according to the ONC report from April 2015.

Interoperability cannot even take shape or show value until this critical mass of EHR users has been established. Once the adoption rate of EHR increases, the “ports” will find a way to be opened for cross communication between different EHR systems. Many practices are holding off on a decision to move to EMR for a variety of reasons. One reason that seems to appear often is the thought of interoperability concerns between physicians and their respective admitting privileges at hospitals. As practicing physicians, investing in the right EHR is paramount to the continued success of a paperless medical practice.

Device selection by provider and mobile access has become the topic in EHR 2015. The term “across all devices” as it pertains to the EHR industry refers to the ability to obtain access and continuity of relative health data regardless of the device being used. It’s the EHR application that holds the consistent flow and crosses platforms into a responsive mode. As interoperability is defined by the data exchange of patient history in an EHR, the term should not be considered when selecting a device. EHR vendors should have this program responsive technical needs at the ready.

True infrastructure roadblocks, problems still lurking to be addressed, and standards put into place are not limited to and do not exclude future changes in technology for a more evolved and easily transmitted data file. EHR vendors are in a very competitive marketplace and their source code is encrypted and held securely. The thought of sharing source code is as guarded as the major cola manufacturers’ recipes. Fear of exposing the code to a competitor is universal. HL7 has been able to allow EHR companies to communicate without revealing their source code. EHR companies are reluctant to communicate one-on-one to enable interoperability. Patient data import and export are equally challenging for the same reason. Patient data records are transferred in the current EHR environment by Comma Separated Values (CSV) for mapping.

Perhaps the implementation of an information exchange clearinghouse database is one possible answer, with contributing EHR vendors who might be willing and open to the idea. This clearinghouse would retain only a mapping code where patient data would come through from one EHR and then, synthesized as source code free data, it will populate the map of the other EHR and produce the medical history at the time of need. No data is left in this hub, on the matrix of a map to the participating EHR companies. The patient medical data can be viewed by patients and physicians as private and secure. This hub at the center of participating EHR vendors can have inbound and outbound ports with source code privacy maintained. A physician requesting patient history at the point of care can be placed through a secure EHR URL and a responding EHR product held by a different physician, maybe at the time of an emergency, can be revealed in a timely and secure manner.  This is data capture and distribution, plain and simple. The data points can be mapped by the competing EHR vendors in advance so when a request from EHR vendor A comes in, the patient data will be released and corresponding fields of requested data will be populated. As an example, known allergies, prescriptions, social or family medical history can be reviewed at the point of care to make fast and safe medical decisions.

Process steps can start from a variety of starting points. In this fast paced electronic world, interoperability will be established, but not before attempts are made to create an efficient thoroughfare for this secure HIPAA compliant data of patient’s vital records. Many steps have been discussed and tried, but a complete and comprehensive solution is not in place.

Patient safety and privacy held to respected standards is a must in the EHR interoperability environment. A physician at the time and place of encounter can have many possible outcomes based on many pieces of information known or unknown. Prescription allergies are very common, according to the American Academy of Allergy Asthma & Immunology.

Drug Allergy

Worldwide, adverse drug reactions may affect up to 10% of the world’s population and affect up to 20% of all hospitalized patients.

If the attending doctor is unaware of a particular allergy at the point of care, many different possible outcomes can be experienced. However, with a fully functioning interoperability standard in place, that same doctor can quickly and accurately investigate the medical history of a patient that might be incoherent and make an informed decision on the appropriate care path. Every patient and every situation are different and individualized, knowledge of that individual in a critical care setting can mean the difference between life and death in many cases. This idea of a health information hub for patient medical history information exchange can be accessed with near immediate results.

EHR data exchange between hospitals can be accomplished with the use of a bridge for interoperability, perhaps with greater ease than private clinics. Hospital-based EHR programs are not as vast in the number of competing companies. Hospitals can have a variety of relationships with organizations such as Group Purchasing Organizations, known as GPOs. In terms of patient data exchange, these different affiliations and relationships are a tremendous step in the right direction. Patient safety is the number one concern and politics of data are a detriment for the overall well-being of the patient. Fear of computer hacking and firewalls in place can block the free flow of patient data. The increasing number of computer network intruders is at an alarming rate with strong indications of continued elevation. Cyber security for EHR companies is requiring the tightening of entry points. These fears are relevant and concerns are warranted, thus an idea of repository data exchange can be seen as more of a viable option rather than a direct connect between two or more institutions.

Doctor to doctor exchange of information via the interoperability of EHR is much more complex than the hospital scenario previously identified. Patient safety and cooperation from doctor to doctor is not the problem in today’s healthcare; it is the EHR vendors’ non-cooperation due to examples identified, i.e. source code revealed. The idea of an EHR hub gathering and distributing patient medical health data in a secure fashion is a proposed first step. Ultimately the patient needs to be the focus.

Primary benefactors of interoperability by EHR vendors and an industry push to make this idea or one like it a reality include:

  • Patients in need of medical care. The medical health record exchange via EHR to EHR interoperability can be proven as a life or death factor. A patient taking a Coumadin for a heart related condition cannot take an over the counter medicine like aspirin. This combination will be proven deadly. The drug to drug interaction episodes are tremendous.
  • Physicians are benefactors due to continued and increased patient record and medical history transparency for better care delivery.
  • Hospital locations can deliver better healthcare with patient information being fed to the attending physician by the private practice physician. A hospital with a fully functioning EHR will not allow free flow exchange of an inpatient health record to a physician with admitting privileges to the hospital. Not because of choice per se, but more about security and possible corruption of detailed medical records. The attending physician at the hospital making rounds while using the hospital EHR currently does not have a safe and secure connection with the EHR being used in their own clinic. A secure hub of mapping matrix can extract patient data from the hospital EHR and deposit the data into the EHR of the physician.
  • Health insurance companies will benefit by cost reduction of the patient medical requirements and the mitigation of duplicate records and medical test or lab orders. Continuity of care for the patient keeps better records of admission and release with a higher propensity of care and better outcomes.

Bizmatics Inc., developer of PrognoCIS EHR, is a forward-thinking company, based on the idea of medical efficiencies and effective behavior to put patients’ lives first, while assisting medical practices capture patient clinical and health data for decision making and tracking. PrognoCIS EHR workflow is medical specialty driven. We hope these combined ideas will produce results in patient care and provider excellence from which everyone will benefit.

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