Nurses are still writing down results provided by one system and manually entering them into another. Patients are irritated that they have to repeatedly detail their medical histories to different providers, often in the same clinic. Pharmacists fax refill orders and spend time on the phone to get patient information. Home healthcare organizations struggle to exchange critical information with hospital systems and medical practices. And, every time data is re-entered, the risk of error increases. The day-to-day frustrations of working in multiple systems and continuing to rely on outdated manual processes are so widespread that it’s come to be an expected part of healthcare.
Much of this friction is due to the (lack of) interoperability of healthcare information. For the past decade, the backbone of healthcare data has been the EHR (electronic health record). But with the evolution of patient portals and health insurance systems, the complexity of interoperability has accelerated — along with the process load and frustrations.
Patient data must be created, managed, and accessed by clinicians and staff from all of a patient’s providers and organizations (including specialists, pharmacies, and laboratories). That data includes medical history, contact information, medications and immunizations, admissions, discharge and transfer notes, allergies and advance directives, care plans, and cognitive functioning. The data is often incomplete, inconsistent, or inaccurate.
How did we get here?
In 2014, electronic health records (EHR) became mandatory as a result of the American Recovery and Reinvestment Act. In addition to healthcare systems and private practice healthcare providers being pushed to making the switch from paper charts to electronic records, the EHR program was also required to meet “meaningful use” to maintain Medicare and Medicaid reimbursement.
This mandate left healthcare organizations with the cumbersome task of deciding which EHR system to purchase. Decision factors included functionality, ease of training, investment, and cost-efficiency, as well as required upkeep and troubleshooting issues. Another crucial component for consideration was security, information protection, and HIPAA compliance.
The time-sensitive and financially-intensive task of converting to EHR led providers to use a trial and error approach while others attempted to build their own EHR system. Both approaches resulted in healthcare providers having to switch from one EHR to another if meaningful use was not met.
Challenges included the transfer of old patient files and compatibility with testing results, imaging, and various paper charts. And the number of required computers increased, as each employee required access to the EHR for inputting and reviewing data. The change fatigue for many healthcare professionals and healthcare workers was substantial.
EMR, EHR, & HIT
In the world of health information technology, interoperability and interface both refer to the electronic transfer of patient data from one health record system to another. Interoperability is the difference between an electronic health record (EHR) and an electronic medical record (EMR).
An EMR is a digital version of a patient’s chart within a single practice or organization. EHR systems meet the nationally recognized interoperability standards. HIMSS (Healthcare Information and Management Systems Society) defines interoperability as the ability of different health information technology (HIT) systems to connect within and across organizational boundaries to cooperatively exchange and utilize data. An EHR system includes patient records from across the healthcare continuum, offering a more complete and holistic view of a patient’s health and medical history than an EMR.
COVID-19 & Legacy Ecosystems
The COVID-19 pandemic has accelerated transformation. The drive to improve care coordination and engage patients in their health has never been more urgent. The current focus with technology is how to improve the ability of health information systems to integrate within and across organizations — with the goals of increasing communication and providing improved patient care.
As we know, Epic, Cerner, and MEDITECH combined have over a 70% EHR market share. Even with these considerable consolidations, the number of technologies enabling EMR in other contexts (patient portals, medication solutions, insurance systems, rounding tools, telemedicine, and remote monitoring devices) continues to grow. Healthcare leaders are seeking technology solutions to innovate past legacy systems and meet the growing demands (and opportunities) of interoperability.
Clinician burnout, medical errors, & information blocking
A recent JAMA study found that in addition to other factors, the load of using inefficient technology systems plays a critical role in clinician burnout. The Agency for Healthcare Research and Quality (AHRQ) reviewed studies supporting that errors frequently occur with medication administration and often with medications that require more complex dosing. As we saw with the COVID-19 pandemic, many of these technology systems struggle to adapt to change and don’t offer the flexibility to provide adequate care to patients. Systems were not prepared for telemedicine visits or for offering telemedicine while billing appropriately and maintaining HIPAA compliance.
Information blocking is still an issue between healthcare providers and from provider to patient. The American Medical Association (AMA) supports bans on information blocking and, after October 6th, 2022, all physicians will be required to make patients’ electronic PHI available for exchange, access, and use. But, changes to technology and systems are necessary to enable that.
The dream of health information exchange (HIE)
EMR, EHR, and HIT all contribute to the dream of Health Information Exchange (HIE). HealthIT.gov defines three key forms of health information exchange:
- Directed Exchange — the ability to send and receive secure information electronically between care providers to support coordinated care
- Query-based Exchange — the ability for providers to find and/or request information on a patient from other providers, often used for unplanned care
- Consumer Mediated Exchange — the ability for patients to aggregate and control the use of their health information among providers
Achieving interoperability across these key forms is critical for the patient, clinician, and administrative experiences that we all want — experiences that will improve patient care, minimize errors, reduce clinician and administrator burnout, and decrease the cost of healthcare.