David Wasserman spends his days advising physician practices throughout Massachusetts on EHR implementations, value-based care, and compliance and coding. He's an advisor with the practice solutions and medical economics group at the Massachusetts Medical Society.
Physicians Practice recently interviewed Wasserman to get his perspective on the EHR interoperability challenge and its impact on physician practices and patient care.
Physicians Practice: Please define the EHR interoperability challenge as you see it.
Wasserman: The EHR interoperability challenge is what stands between a physician's ability to look up, extract, and track a patient's medical activities and records at medical sites other than their own. This could be at a laboratory where a patient's specialty blood work is being analyzed or they're having surgery on an inpatient or outpatient basis.
When it comes to tracking these patients, it's literally as they move about in the sphere of the healthcare world. The interoperability challenge occurs because you need your EHR to talk to systems outside your practice.
Physicians Practice: What could solving the EHR interoperability challenge mean for patient care?
Wasserman: Solving this challenge means maintaining continuity of care for patients, minimizing or eliminating the duplicity of services, and helping physicians share patient information so they can gain insight from specialists that would complement their diagnoses.
Physicians Practice: Why is this problem so hard to solve?
Wasserman: Many EHR companies aren't willing to share access to their systems unless a physician is part of their overall user base. If you work in a particular hospital or practice that has their product, these particular companies will share information with physicians. The problem is they won't work with peripheral players, or physicians who are unaffiliated with the hospital or practice where their EHR is installed.
Physicians Practice: In your experience working with small- to medium-sized physician practices, what has worked?
Wasserman: The physicians who have been able to get through the quicksand and connect with hospitals have affiliations with those institutions. They don't have to be owned or operated by a particular system, but they do refer patients to that system. This could be for inpatient care or specialty laboratory services. In those cases, those physician practices know the gatekeeper who will allow them access to the [hospital's] EHR and other systems.
What also works best is when a physician has a good relationship with a particular patient. That means that if your patient has a good relationship with you as a physician, your patient can then ask for the hospital to provide you with access to their systems. Providing you with access to your patient via the hospital's EHR means you can track their progress.
Physicians Practice: Why is it in the hospital's interest to provide access to patients via their EHR?
Wasserman: Sharing access to patients via the hospital's EHR creates a win-win situation where the hospital can keep the patient in their system.
Physicians Practice: What do you recommend if the hospital won't provide the physician at your practice with access to their patient via the EHR?
Wasserman: It comes down to paper or hard copies of your patient's records and radiology reports and labs — or they can be carried around on USBs. Your patient has access to their medical records at their beck and call. Anytime that request is brought to their physician, it has to be honored.
Physicians Practice: What would you do if you were in a position to increase physicians' access to their patients' records in hospitals' EHRs?
Wasserman: I think you have to go slowly. Ideally, all parties — as in physicians, hospitals and physician groups, and EHR vendors — must come together to drive this, and they have to put the patient first, and their cash second.