A number of barriers block the way to widespread EMR interoperability. One echoes the “too many cooks in the kitchen” cliché. Each EMR vendor has developed its own solution that includes proprietary programs and data conventions, and each vendor naturally touts its solution as the best one for you.

And as in any sector, EMR vendors generally don’t like to share. And who can blame them, really? Opening the export floodgates has a definite down side: While doing so is certainly helpful to you, your patients, and U.S. healthcare quality, it unlocks the exit door for clients.

Well, that’s just vendor greed or paranoia, right? Perhaps not. For the first time in our annual Technology Survey, the number of practices who said they use an EMR actually decreased. OK, maybe it’s just a blip — or not. It could be an indication we’ve reached a second wave of EMR purchasing, that many physicians are unhappy with their first EMR purchase. “People try out vendors,” says Bertman. “Then they find out it’s overpriced. They want to transfer their data.”

Why should vendors risk losing their paycheck-funders by allowing clients to grab their data off one EMR and load it onto another? What’s in it for them? That’s normal business, American-style, and so these are valid questions.

Worth the Trouble EMR interoperability is a headache. Why bother? Three reasons leap to mind: Patient safety — Nobody would argue that reducing or eliminating medical errors is a bad thing. One way to help keep your patients safe is to have their complete medical history. The problem? “Patients are the worst people to interview in terms of correct history,” says Bobbi Summers, an applications specialist at Huron Gastroenterology Associates in Ypsilanti, Mich. They forget what meds they’re taking and they may not mention critical facts that could change how you develop your treatment plan. Accessibility — Think of full, nationwide EMR operability as akin to the Internet. You’re hooked into hundreds of thousands of other computers, with only a keyboard between you and zillions of bytes of information. That’s what we need for EMRs (with all the proper check stations for patient privacy issues, of course). A few keystrokes and you’ve pushed all the information the hospital needs to effectively assess a patient you just admitted for chest pain. Or, say one of your adult patients careens off a Razor scooter while out of town and undergoes surgery to mend her broken leg. With interoperability, the hospital will know all the medications she currently takes, even if she’s unconscious. And you’ll get a complete note of the whole experience. Efficiency — Enough with the duplicate data lurking all over the place. Hard — no, make that impossible — to keep everything updated, even if everyone is paperless within their own offices. It’s incredibly time-consuming for staffers in multiple practices to ask the same questions and type in the same answers over and over, when they could be accessing a centralized repository that alerts them to changes in a patient’s information.

Another impediment to EMR interoperability is the way many EMRs are designed. Not to get too geek-speaky here, but the programming languages used to write all but the most recent EMRs are problematic to widespread use. Have you ever struggled to install some software on your computer that works great on your friend’s setup but it keeps crashing on yours? Same goes for first-generation EMRs. Many were created in such old-school languages as Visual Basic and C++, which are highly system-dependent. Making them work across all systems without hiccupping is a real challenge.

The same goes for the EMR’s data. Passing data between two EMRs requires flexibility on both sides. Many EMRs are incapable of bending and stretching their data architecture to fit another. Imagine trying to yank on a bathing suit that is two sizes too small.

Still another issue hampering true interoperability is that it does not mean just EMR-to-EMR. It also means provider/patient communication, claims submission, insurance verification, test results sharing, computerized physician order entry, electronic prescribing, and probably other functions. This requires a national platform that payers, physicians, vendors, pharmacies, hospitals, and you name who else, must agree to. See the problem?

What can you do?

Yes, you’re a physician — certainly more than a full-time job. And you’re in a career that’s fraught with regulations. But hammering out EMR interoperability standards — that’s an opportunity to participate in something where the rules are not yet etched in stone. Hmm, you could get involved. But how?

• Get on board. EMR vendors aren’t the only ones guilty of foot dragging. The phlegmatic adoption of EMR technology by physicians in the U.S. hasn’t helped the cause either. If you’re still paper chart-based, you’ve got two hurdles to clear: the technology itself, and then the subsequent interoperable data sharing. This is a concern for many doctors, says Decker. “It’s a cultural challenge; there’s still a lot of nervousness. Do I really want to send out my patient data?”
  
  
• Guard your patients’ privacy. Certainly no technology meets every healthcare need — even EMR. But take a look at “Physicians’ Use of Electronic Medical Records” below. Overlay these results onto “Test Results or Medical Records Not Available at Time of Appointment, Among Sicker Adults.” The two charts dovetail pretty neatly, don’t they? When building a cabinet, such dovetailing is great. With patient care, not so much.
  
  
• Voice your support. If you don’t already have an EMR, choose a vendor who puts interoperability way high on its priority list. For those who claim they do, push them to define what interoperability means to them. Communicating with other products they’ve created? Uh-uh, not good enough.
  
  
• Keep your data door open to the outside world. “It’s one thing to say you’re interoperable,” says Bertman. “It’s another to let you truly take the data out.” Decker recommends putting CCHIT certification in your EMR RFP (Request for Proposal), which hopefully you’ll choose to write before you invest in this technology.
  
  Even if you already have a system in place, ask your vendor where it stands on interoperability. Make it very clear that this is of supreme interest to you. “Demand that vendors go down the CCHIT path,” he says. After all, McDonald Happy Meals were only a special, temporary promotion when they first came out in the late 70s. It was customer support that got them onto the permanent menu, much to our kids’ delight.
  
  
• Join health IT advocacy organizations, such as eHealth Initiative, an independent, not-for-profit organization whose stated goal is to “drive improvement in the quality, safety, and efficiency of healthcare through information and information technology.” Also consider CCHIT, which also is largely volunteer-driven, or maybe just CHIT, the Center for Health Information Technology, which is part of the AAFP (the co-sponsor of the CCR).

Basically, the louder you proclaim you want full EMR interoperability, the more quickly a viable solution will gel. And it is happening. “Clients are really starting to push it,” says Decker. “And it’s the right thing to do.”