EHRs Need to Talk to Each Other

One of the major drawbacks of the EHR is the lack of interoperability between software systems and environments. Even though the data is digital, there has not been a lot of progress toward making that data available external to the system, and between systems and health care facilities.

This is a big problem in our practice. We use an EHR, but there is no easy way in which to access or import data from another EHR system when we see patients for consults. We are forced to rely on paper records to review past medical and surgical histories, medications, allergies, etc., as we evaluate a new patient. Many EHRs don’t have a patient portal that allows patients to access their EHR via the Internet and their handheld devices.

The inroads of the EHR have been significant in the past six years. According to the CDC, 75 percent of physicians are now using an EHR, as is virtually every hospital in the United States.  This means that nearly all patients have an electronic “footprint” of their health data in the system. The problem lies in the lack of communication and compatibility between and among the variety of systems that are out there.

Progress was made towards addressing these significant limitations of the EHR in a public-private partnership announced in February 2016 by the U.S. Department of Health and Human Services. Health IT companies and health care systems have agreed to:

• Implement application programming interface (API) technology so that smartphone and tablet apps can be created, facilitating patient use and transfer of their health care data.
• Work so providers can share patient health care data with patients and other providers whenever permitted by law, while not blocking such sharing either intentionally or unintentionally.
• Use the federally recognized Fast Healthcare Interoperability Resources (FHIR) data standard.

While this seems like a “Kumbaya” moment, the devil is usually in the details. EHR companies have a tremendous interest in seeing that their proprietary technology is protected, and I can see some resistance to this movement by the same vendors. We need to be able rapidly and efficiently move patient information from the systems that have it to the systems that need it in the care and interest of the patient; while simultaneously protecting the confidentiality of the patient. This is no easy task.

One of the things that I have noticed is that the “evolution” of the EHR has made a dramatic shift over the past decade. The original EHRs were about the needs of the system, to gather the information that the system needed for billing, reporting, etc. The needs of the providers at the point of the sword were an afterthought, and the interfaces and the difficulty of using early EHRs reflected this bias.

Over the last year or two, significant emphasis has been placed on the provider end of the EHR, to make it more intuitive, and functional in the work of documenting patient care, and presenting the data to the provider so that the provider needs to safely and efficiently care for patients in and out-patient environment. We are seeing better and more linear interfaces in the hospital that present the patient data, and allow for the quick and efficient documentation of patient care. We are also seeing the migration of EHR software to portable devices such as smartphones and tablets. However, until we solve the behind the scenes interoperability issues that are faced by disparate incompatible systems, we will reach a roadblock preventing us from moving forward on the EHR front.

We have been using a tablet-based EHR in our private practice for three years, and would never go back to the other data management systems we have used in the past. Our hospital system is in the process of rolling out a tablet based implementation of the industrial strength EHR they have been using for years. It has promise, but there is still work to be done.

As an end user, with the interest of the patients under my care in mind, I’m all for all of the players in the EHR industry working together. It is about better patient care, and about being able to use the data in a way that makes our communities better and safer. I may not be alive to see the promise of the EHR fully delivered, but I can see the finish line and it is in the not-too-distant future.