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EHR interoperability is a great idea in theory, but the reality leaves much to be desired.
Interoperability was touted as the promise of electronic health records (EHRs). The vision was to create systems that could communicate with each other, making patient records available wherever and whenever they may are treated. While some systems talk with each other, the truth is that we do not yet have wide-scale interoperability in the healthcare system.
Integration is needed in order for disparate systems to share data. Different vendors need to work together to make interoperability a reality. And, for the most part, EHR vendors are not willing to do this. They have little incentive to build a bridge to another company’s software. After all, they’re a business, and they’d rather sell their own products than share with their competitors.
As a result, providers are stuck in the middle, and that puts patient care at a halt - and a disadvantage. Here are five ways the failed promise of interoperability interferes with daily practice.
In the past, labs and radiology facilities would fax or mail results to physicians’ offices. Today, some have the capability to integrate with certain systems to directly upload data into the EHR. Unfortunately, many do not.
The results still get faxed and mailed to us. Then we need to scan, download, and upload them into the patients’ charts. This clearly involves extra steps and extra time, none of which we’re paid for but need to do for proper documentation and the best patient care.
Interoperability makes it harder to get information that isn’t shared but should be. One of our local hospitals is supposed to be integrated with our system. But sometimes, the results don’t appear in our EHR. We then have to call and request the results. The clerk then argues we already have access to it.
When we finally convince him/her that we don’t have it, the clerk will fax it over, maybe within 15 minutes, maybe within 15 hours. Patients get upset waiting that long for the fax to come, and we’re left waiting until it does.
When systems stop communicating with each other, no one is to blame. One of our local labs is integrated with our EHR but for two weeks, none of the lab results appeared in our EHR. We called the lab and after a 30-minute hold, we were told it was the fault of our EHR software. After another 30-minute hold and an hour and a half phone conversation with our EHR vendor, we were told the fault was with the lab software.
We were going back and forth between both companies for several days. In the meantime, we had to have all the results faxed over, scanned in, downloaded and then uploaded. Once the integration suddenly started working again, we then had double lab entries in all those charts from the previous two weeks, meaning we had to spend even more time reviewing and removing those duplicate results.
Software vendors don’t all do their updates at the same time. When the system is down for one system to update, the others are still going. Then those are down at other times, creating a never-ending cycle of updates.
When a system is down, it doesn’t integrate with the others. In other words, we need to repeat the familiar yet frustrating process of faxing, scanning, downloading and uploading the data.
Keystoke errors in data input can lead to prolonged searches. For example, if my practice doesn’t enter the patient’s middle initial but the pharmacy does, that creates a data mismatch, meaning the prescription will not be recorded in the patient’s chart. Sometimes a simple search will resolve the issue, but it is often more complicated.
When the patient comes for the follow-up appointment and the results are not in the EHR, we end up calling to request the results (maybe after a 15 to 20 minute hold) and they are then faxed over. Those records then they have to - you guessed it - be scanned, downloaded and uploaded into our EHR system.
Where no bridge exists, a website may offer a connection. Many third-party companies now allow providers to access online portals to view results or records. This can be a great workaround if you are dealing with only one or two sites, but it becomes a very complex process when there are six or seven sites to look up, access, download and upload results.
Interoperability is a great idea, but we are still far from achieving it. And, in my opinion, I doubt we ever will. In the meantime, the lack of interoperability place burdens and waste time from a physician’s daily practice.