Interoperability: the Solution for EHR Frustrations
By Ruby Raley
Physicians are frustrated with EHRs – in part, because EHRs often do not allow for the transfer of patient records to colleagues outside of their own network. This frustration is a thorn in the side of healthcare – one that quickly needs to be removed.
More efficient interoperability is on the way to help streamline the industry, but the important question we need to ask today is this: What can doctors do in the meantime, while they wait for better interoperability?
First, let’s consider why physicians are frustrated with EHRs.
EHR/EMR vendors initially focused on the clinical workflow, as it was critical to capture information and fit it into the practice routines. It was less important for information to be shared externally when workflow and usability were critical to productivity for physician offices. Physician practices can experience a drop in the number of patients seen in a day when they have to enter data into an EHR. A few years ago, vendors were focused on solving this roadblock – physicians could not afford an EHR if their revenues dropped on adoption.
While the good news is the industry is maturing. The bad news is that we have a new issue: We need to improve care coordination, and more fully engage the patient in their own healthcare decisions and course of treatment. The pressure is on from government and consumer advocates to exchange data freely – the ONC interoperability roadmap calls this out explicitly.
What are the issues now? Vendors often charge extra for connectivity, especially point-to-point interfaces between partners in the healthcare community. Direct (a secure email exchange program) was conceived to address this issue, and this approach has seen steady adoption over time. However, a few issues with the automation remain. Direct can require practice team members to review and manually load the secure email received from all partners. This is time consuming, and it is time that small practices and busy physicians can’t afford. Direct can interoperate with more sophisticated use cases. There are protocols that enable cross-community collaboration (XCA), but these have not been consistently adopted by industry and some offices do not have the technical skills to support this type of exchange without external help from a vendor or service provider – leading to more cost.
HIEs were envisioned and subsidized by ONC with grants to serve as a clearinghouse and facilitator of clinical data exchange at a state level. HIEs received a lot of press and focus, which led to limited success in communities and states across the U.S., but never achieved the goal of ubiquitous data exchange.
There are a few changes on the horizon that may offer a solution to the challenges of interoperability. ONC has stated it intends to ‘encourage interoperability’ through public information sharing (or shaming) and regulatory pressure from CMS. Congress has even held hearings on interoperability – challenging vendors to make it simple and cheap (or free) to share data with others. Vendors are forming alliances to promote interoperability and including data exchange functionality in base releases. Many see the challenges of data exchange easing and gradually disappearing through the work of the vendor community. Additionally, a new protocol, FHIR, has emerged to address some of the challenges of sharing Continuity of Care Documents (CCDs). (You can think of a CCD as an electronic version of your paper chart that the doctor reviewed and marked on your visit). FHIR makes it easy to share only the portion of the CCD needed – medications, for example. FHIR is receiving a lot of attention, but it is not yet widely adopted. In a few years, we may see this as a widely used protocol for data exchange.
What can physicians do about it? They should expect data exchange to be included in their EHR platform. Ask questions and seek this functionality in new releases or when purchasing a new platform. Physicians should look to join communities that facilitate data exchange – such as HISP (a service provider for the Direct solution). Advocacy is important for all of us – there are real advantages to data exchange, and we all can benefit. Vendors who get that value of data exchange will do more than move data from one door step to another (data interoperability). They will ensure process interoperability is achieved – cleansing and consuming the data so it is usable without manual effort. Process interoperability is essential for the physician office. Physicians want to focus on helping patients; most do not want to juggle technical issues and program workarounds in their systems. The vendor community with support and guidance from regulators must provide the tools and capabilities to resolve the challenge.
Ruby Raley is executive vice president of product strategy at Edifecs.