EHR & Interoperability, the challenge of making Electronic Data Usable
EHR platforms have been adopted widely by hospitals and providers across the world. With the surge in number of hospitals willing to make patient records interoperable, challenge for EHR vendors lies in creating a system that offers multiple interoperability formats of sharing data. Most systems are designed keeping in mind the needs of the hospitals & enterprises and sharing data between disparate systems poses a huge challenge as systems don’t follow the standard format of sharing data. Over the years, interoperability has remained more as a healthcare hot topic and it’s not utilized to its full potential.
EHR systems, patient portals, Patient engagement platforms, telemedicine solutions are some of the most important solutions of digital healthcare ecosystem. It’s the interconnectedness and their interoperability that binds the entire ecosystem together.
Interoperability plays a huge role in providing Proactive Care Delivery to the patients. For it to work, EHR and other Health IT (HIT) systems should be able exchange meaningful clinical data in an accurate and efficient way.
According to the ONC data brief in April 2019, 82 % of hospitals use EHR data for quality improvement. As per the AHA survey on EHR trends and use by hospitals
- 81% utilize EHR data to monitor patient safety
- 68% use EHR data for identifying and monitoring high risk patient
- 71% use it to measure health of the organization
- 67% use data to create individual providers profile
Though the adoption of EHR has increased, the challenge with interoperability continues as these systems still operate on hospital’s requirement and collect data in silos. Add to this, lack of standardization of data has created hurdles in achieving the ultimate objective of providing better patient experience. i.e. care coordination and to provide better Patient Outcomes.
There are plenty of scenarios where Patient data needs to be transferred between facilities to provide proper treatment to the patients but in the absence of patient data, providers are not able to make informed decisions and are not able to stay up to date with Patient’s medical history. Imagine a patient who is already distressed and in pain, is being transferred from one hospital to the other in different region and all his information is not made available to the hospital that he is being transferred to. Sometimes Patient’s insurance details are not exchanged that delays the treatment further. EHR is the crucial component for the inter and intra state transfer of the patient and it aims to provide better Patient Care to the Patient.
To push interoperability, in 2019 Medicare and Medicaid Promoting Interoperability Programs (IP) (officially known as Meaningful Use) were initiated to incentivize EHR interoperability among providers.
However, in reality interoperability and seamless exchange of data sharing is in a chaos due to numerous factors that include the following:
No Standard format of Patient Identification across HIEs
The lack of standard format for Patient Identification across HIEs has plagued the utility of interoperability. Large healthcare enterprise systems, the network of providers, all use different parameters for identifying a patient. Commonly used parameters include – patient name, date of birth, social security number. The trouble arises as this information is stored in different formats in different systems that may create scenarios of identification errors.
Advocacy groups such as HIMSS and CHIME had pushed for the use of National Patient Identifier (NPID) in the form of alpha numeric code. The proposed NPID could have been utilized to identify patients across HIEs and EHR systems. The Health Insurance Portability & Accountability Act of 1996 (HIPAA) too proposed the creation of Unique Patient Identifier but it was revoked citing privacy issues.
EHR are used as the first repositories and as a source to access patient’s health data within the provider’s ecosystem and HIEs. The lack of a single parameter to identify patient’s health data has resulted in exorbitant healthcare cost, stifling of better health outcomes, inefficiency in health data exchange and safety threats.
EHR supporting interoperability will provide better patient and population health outcomes. Working on a single interoperable system can also help tertiary centers. They don’t have to do rerun the tests again of the patients transferred from PHCs as the details of patient’s condition are already captured in the system.
No Standard format for sharing data between Health Systems & difficulty in analyzing data
The lack of standard format for sharing data and as disparate systems don’t communicate in the same language, the meaningful exchange of data becomes difficult. Since there is no standard format of sharing data it’s challenging for the providers, payers and vendor partners to gauge the impact of delays and failure in interoperability. Often, when the data is exchange it needs to be sanitized (incompatible fonts, external data fields, and proprietary formats) which creates high chances of data manipulation.
As per the Office of the National Coordinator (ONC), “health care organizations exchange information according to a set of standards. Standards are agreed-upon methods for connecting systems together. Standards may pertain to security, data transport, data format or structure, or the meanings of codes or terms. Standards are defined, updated, and maintained by standards development organizations (SDOs) through a collaborative process involving the audience that will be using the standards but there is no single standard.
A successful EHR implementation requires a health system to find more efficient way to connect & make fragmented patient data available to other systems. Since there is no defined interoperability standard for capturing, transmitting, receiving and storing data, managing patient data becomes challenging and it causes major hurdle to exchanging data in meaningful ways.
For seamless exchange of health data, EHR systems must follow HL7 and FHIR (Fast Healthcare Interoperability Resources) standards that define conventional data formats. FHIR is a next generation standards framework created by HL7 (Health Level Seven International). It combines the best features of HL7’s v2, HL7 v3 and CDA product lines while leveraging the latest web standards and applying a tight focus on implementability.
Payers refusing to participate in data sharing
Providers and government would benefit a great deal from the huge amount of data accumulated by Payers to improve population health outcomes. The lack of participation by payers and more payers switching to private HIEs has increased the cost of integration and added to interoperability challenges for providers.
Data blocking by some EHR vendors is a major impediment to achieving the goal of interoperability. Some technology companies block the information and then levy fees for transmitting data outside the system. This practice disrupts the flow of data. In Op-ed published in Stat, Joel White, Executive Director of Health IT Now stated, “More than 600 days after the enactment of the Cures Act, not a single regulation has been issued on information blocking.” He had called for the publication of any regulation on information blocking as needed by 21st Century Cures Act Legislation. The core objectives of the legislation include encouraging interoperability of EHR and discouraging information blocking.
High Cost of Integration
Healthcare providers utilize multiple health technology systems for tracking and analyzing PHI for better Patient and hospital outcomes. However, these systems are not easy to use and their connectivity and integration with other disparate systems and HIT systems leads to a significant cost that most providers can’t afford. As per a Healthcare IT Article – HMISS data reflected that health care network engage with up to 18 different EHR systems. This makes the process of transmitting, receiving and analyzing data sluggish and prone to error.
HOPS EHR-HMIS is a HIPAA compliant system with HL7 integration that supports the standard formats (multiple formats) of sharing data which makes it compatible for exchanging data between the systems through HIEs. For achieving true interoperability and better Patient Outcome our system integrates remote centers with main hospital. This enables doctors to manage patients remotely through telehealth integration and improves surveillance at the remote centers. It enables providers to come up with better Patient outcome by providing clinical dashboard that provides analytical data. our EHR system is integrated with Patient Portal that allows Patient to be on the top of the medical information. Integrated Patient App allows patient to have complete access to their medical records, book telemedicine video consultation with the doctors, and order medicines. The system supports hosts of features and is a scalable and a customizable platform that can meet the needs of different types of providers and help them achieve the objective of meaningful exchange of patient data. Read more about our case study here.
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