Healthcare // Analytics
Commentary
6/14/2013
04:27 PM
Chris Murphy
Chris Murphy
Commentary
Connect Directly
LinkedIn
Twitter
Google+
RSS
E-Mail
50%
50%

Sharing Electronic Medical Records Still Too Hard

Epic CEO Judy Faulkner and other health execs aren't thrilled with the state of EHR interoperability. What are today's big barriers?

Q: Why aren't there better ties to specialist systems, from optometry to cardiology, to easily update the EHR?

The question came from Scott Jens, founder of RevolutionEHR for optometrists. Faulkner asked how many optometry records vendors there are, and Jens said about 30. That kind of software sprawl exists in every specialty practice area. If Epic worked on interfaces for all the vendors that wanted to integrate, "we would do no more development on our software," Faulkner said. "All we would do would be interfacing to the other vendors. … We would need thousands of programmers just to be on top of that."

Q: Is some kind of central repository for some core health data the answer?

Such a repository would face the same challenge Epic does in contemplating integration, said Faulkner: Does that repository have an army of developers to write and maintain all the necessary interfaces to the systems that will contribute data?

Ferguson at Kaiser Permanente was unequivocal: "Bad idea." One, he said, a central repository is a huge breach target. Two, the opportunity for conflicts of interest are insurmountable. Three, the expense is unsustainable to maintain a big central repository and normalize all that data. Instead, the better option is standards-based exchange efforts, such as the national e-health exchange started by ONC.

Q: Is the answer a simpler download to a personal record, so people do their own aggregating of health data sources?

Kaiser Permanente has let people download their own record for years, but there isn't an easy way to transfer that mass of data into a third-party, consumer record. "The technical barriers are way too high today," Ferguson said.

The list of independent, consumer-focused personal health records that have flopped is long and distinguished, including both Microsoft and Google. Byrne is betting on EHR vendors providing access via PCs or smartphones, such as Epic's MyChart service. Given the parade of failed personal health record startups, "I like my chances better picking up my iPhone and pulling up MyChart, and I can do that today," he said.

Q: What other barriers are there to interoperability?

Financial incentives are one barrier, Ferguson said, because fee-for-service medicine doesn't provide the incentive for sharing information. Accountable care and integrated care models have "native incentives for having complete information and sharing," he said.

Faulkner listed several barriers. One is patient control, which Epic hit with its earliest efforts to allow data transfers. "What we found right away is people wanted to share with people they felt comfortable sharing with and not with others," she said.

Another is lack of training, she said. Emergency rooms generally are steeped in how to exchange data and gather what they need, but there are many other areas that could use Epic's interoperability platform where they aren't trained in data exchange. Ferguson seconded the training obstacle, saying it's particularly tough in settings where clinicians only rarely exchange data and thus struggle to remember how to do it. "That's one of the reasons we have such low exchange rates even where the technical capability exists," he said.

This isn't a comprehensive list of barriers to interoperability, only some of the highlights from a good discussion. Are there others you would add? Please share them in the comments below.

Previous
2 of 2
Next
Comment  | 
Print  | 
More Insights
Comments
Newest First  |  Oldest First  |  Threaded View
Page 1 / 2   >   >>
cbabcock
50%
50%
cbabcock,
User Rank: Strategist
8/20/2013 | 12:03:29 AM
re: Sharing Electronic Medical Records Still Too Hard
Open source code projects rarely set up standards, then require participants to swear an oath of to follow them. On the contrary, they have many parties submitting code from various viewpoints and a founder of the project, or a trusted inner circle of committers, deciding which ones conform to the goal of the project and enhance it without interfering with already-established operations. It's a benevolent dictator model, and while the analogy is imperfect, I wish some force -- the Centers for Medicare and Medicaid Processing? -- would impose it on all medical record formats.
Ivan Miller
50%
50%
Ivan Miller,
User Rank: Apprentice
7/20/2013 | 3:44:18 AM
re: Sharing Electronic Medical Records Still Too Hard
I'll add to your list of barriers for interoperability all day long, if you'd please show us just one clear path to smooth, reliable interoperability (within budget.)
Out of over 600 EHRs certified in 2011 for ambulatory clinics, less than 18 of them now certify for basic standards of interoperability. The reality is those disparate systems were not developed to work together in the first place. Therefore, any efforts for "interoperability" can only be a temporary fix. (Ie. "make-do" or "work-around")
Problematic, temporary fixes do not work in medicine.

At some point we'll have to give up the "jury-rigging" of current EHRs to adopt a more viable solution. A solution which is thoroughly planned & professionally developed from scratch. Essentially, it'd be what Epic has provided to the large hospitals, but for ambulatory medicine.
SusuE709
50%
50%
SusuE709,
User Rank: Apprentice
7/6/2013 | 4:16:47 PM
re: Sharing Electronic Medical Records Still Too Hard
wow .. it seems the technology will take over everything susu kambing
anon4536176453
50%
50%
anon4536176453,
User Rank: Apprentice
7/3/2013 | 2:46:21 PM
re: Sharing Electronic Medical Records Still Too Hard
Although no silver bullet, a document-based sharing architecture using CCDA would not be a bad idea. I think the driving force will not be PHRs, though -- if large insurers began demanding CCDA-based documentation as electronic claims attachments -- e.g. lab orders and results, for example -- and didn't pay for redundant labs for the same patient, then a lot of de facto interoperability would fall into place. See Wes Rishel on CCDA http://blogs.gartner.com/wes_r... and the NCVHS claims attachment summary from 9/2012 http://www.ncvhs.hhs.gov/12030...
jaysimmons
50%
50%
jaysimmons,
User Rank: Apprentice
7/1/2013 | 1:56:17 AM
re: Sharing Electronic Medical Records Still Too Hard
I agree, the focus needs to shift more control over data to
the patients themselves. Patients need access to their data and need to be able
to share their data with physicians wherever they go. I like that you touched
on the point of all data versus selective sharing of only high level data. If
we can select only the data that is really needed and standardize that somehow
we may start seeing some results here.

Jay Simmons
information Week Contributor
slangpdx
50%
50%
slangpdx,
User Rank: Apprentice
6/26/2013 | 6:44:22 PM
re: Sharing Electronic Medical Records Still Too Hard
The real issue is proprietary systems not talking to each other. Epic being the worst example, thus forcing everyone else to buy into their system. VA Vista has been working for years before the advent of meaningful use and is downloadable for free, some software providers have installed it at no development cost. The state of Indiana has had its own highly interconnected and efficient system for years, again long before meaningful use.

Someone in my office has a relative who was laid off from the Medplus physician EMR sales/training division in March. Their business fell off a cliff at the end of 2012. The reason of course was the end of the first two years of the most profitable meaningful use payments. The apparent message is that all the existing doctors offices who were going to implement EHR have already done it, and that I believe is only about 30%. Since most of those were most likely the larger practices who could afford it, most doctors will never implement EHR outside of assistance from a regional nonprofit source such as OCHIN in Oregon.
Harveyuk
50%
50%
Harveyuk,
User Rank: Apprentice
6/18/2013 | 9:22:11 PM
re: Sharing Electronic Medical Records Still Too Hard
I would strongly urge you to watch a TedMed 2013 talk by Ryan Panchadsaram
http://tedmed.com/talks/show?i...
The way I am displaying my Personal Health Record is just another way of expressing clinical information, but in a format that I, my elderly parents and my children can understand more easily.
As you will see from the video, you should have access to your health data and it seems that this is covered under HIPPA (Sorry I am not from the USA, so do not know your laws in detail.)
cbabcock
50%
50%
cbabcock,
User Rank: Strategist
6/18/2013 | 2:33:28 AM
re: Sharing Electronic Medical Records Still Too Hard
There are good reasons for it, but the health care industry is essentially playing a defensive game, on its own behalf as well as patients. There are too many malpractice suits,too much testing done to prevent malpractice suits and too little standard patient data put in EMRs to be shared among authorized providers. Charlie Babcock, senior writer, InformationWeek
Harveyuk
50%
50%
Harveyuk,
User Rank: Apprentice
6/17/2013 | 9:57:29 PM
re: Sharing Electronic Medical Records Still Too Hard
Not a product off the shelf but technology available today just needs a bit of "Tweeking" which currently I do manually. But could be automated from SnomedCT or any other code (ICD10 ETC).
But as you can appreciate, that would take investment and time (and a PHD in C#), and a willingness from IT Healthcare suppliers to share data and clinical codes and accept them back!
ChrisMurphy
50%
50%
ChrisMurphy,
User Rank: Author
6/17/2013 | 9:30:53 PM
re: Sharing Electronic Medical Records Still Too Hard
I like the comparison to SnomedCT as currency. I watched the video -- is that a real product you can use today? How do you get all that data into it?
Page 1 / 2   >   >>
Big Love for Big Data? The Remedy for Healthcare Quality Improvements
Big Love for Big Data? The Remedy for Healthcare Quality Improvements
Healthcare data is nothing new, but yet, why do healthcare improvements from quantifiable data seem almost rare today? Healthcare administrators have a wealth of data accessible to them but aren't sure how much of that data is usable or even correct.
Register for InformationWeek Newsletters
White Papers
Current Issue
InformationWeek Must Reads Oct. 21, 2014
InformationWeek's new Must Reads is a compendium of our best recent coverage of digital strategy. Learn why you should learn to embrace DevOps, how to avoid roadblocks for digital projects, what the five steps to API management are, and more.
Video
Slideshows
Twitter Feed
InformationWeek Radio
Archived InformationWeek Radio
A roundup of the top stories and trends on InformationWeek.com
Sponsored Live Streaming Video
Everything You've Been Told About Mobility Is Wrong
Attend this video symposium with Sean Wisdom, Global Director of Mobility Solutions, and learn about how you can harness powerful new products to mobilize your business potential.