Healthcare // Analytics
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6/14/2013
04:27 PM
Chris Murphy
Chris Murphy
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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?

9 Mobile EHRs Compete For Doctors' Attention
9 Mobile EHRs Compete For Doctors' Attention
(click image for larger view and for slideshow)
The average patient can't fathom why the sharing of electronic medical records is so hard. But those inside healthcare aren't thrilled either with the state of electronic record interoperability, as several smart discussions at this week's Digital Healthcare Conference in Madison, Wis., showed.

"If we're this far into this implementation across the country, and we still have this level of discordance, shame on us," said Dr. Frank Byrne, president of Wisconsin's St. Mary's Hospital. "How did we get here and how do we get out? Because we've created barriers."

Epic CEO and founder Judy Faulkner highlighted some of the obstacles to data sharing, from patients wanting to control such sharing, to difficulty training clinicians, to the many technical challenges. While data-definition standards in theory should make sharing easier, "the standards are only describing a very, very small subset of the data that's really there," Faulkner said.

[ Mobile EHR apps are set to take off. Read EHR Makers Answer Doctors' Calls For Mobile Apps. ]

Here are a few of the broad questions about interoperability discussed at the DHC 2013 event, with input drawn from several speakers and sessions. What's missing? Share your thoughts in the comments below.

Q: Shouldn't data standards allow easier sharing across vendor systems?

Faulkner sounded a skeptical chord about today's standards solving interoperability. There are about 110,00 data elements in the electronic health record, she said, and existing data-definition standards don't come close to capturing the full scope of what's in electronic records. What's more, Faulkner said she is a bit worried about standards as a double-edged sword -- standards might improve communications, but limit innovation and new ideas. "That has to be always balanced as well," she said.

A more hopeful view of standards came from Jamie Ferguson, VP of health IT strategy and policy for Kaiser Permanente, one of the nation's largest managed healthcare groups. Ferguson said standards are "perfectly good" for standardizing close to two thirds of the needed records. But he said EHRs generally aren't implemented well based on the standards.

Byrne said that as a practical matter, interoperability is working locally for St. Mary's and neighboring health system around Madison because many use Epic EHRs, making data compatibility easier. Direct Epic-to-Epic data exchanges will be most common, he said, but it's also exploring and supporting other exchange-based options. Byrne, Faulkner and Ferguson shared a panel discussing interoperability.

Q: Why isn't there an API culture in healthcare?

Big software platforms in other industries use application programming interfaces (APIs) to allow integration and development of add-on applications by third-party software makers. APIs have fueled the boom in mobile app development.

Although mobile app development has picked up in healthcare, it would benefit from more extensive APIs for medical record data, said Judy Murphy, deputy coordinator of programs and policy for the Office of the National Coordinator (ONC) for Health IT, in a separate presentation at DHC 2013. "Many, many of the electronic health records are still proprietary and closed, they don't publish APIs, they don't allow app developers to access their information," Murphy said. "And that's part of what we're trying to change." She cited open government data efforts such as Medicare's and Medicaid's that have led to new mobile apps, such as iBlueButton.

Faulkner emphasized the openness Epic does allow: Epic releases its source code to customers, and will train providers' developers on the system and all the ways they can pull out data for their use. "What we don't do is release that to other vendors," she said.

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Harveyuk
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Harveyuk,
User Rank: Apprentice
6/17/2013 | 6:55:34 PM
re: Sharing Electronic Medical Records Still Too Hard
Do we need every single Blood Pressure, every single vital sign into a shared Electronic Patient Record?
At the moment, in IT Healthcare throughout the world, there is thought that ALL data should be transferable so various healthcare suppliers can see on their own systems micro details of information.

But in the fog of this detail, there is a person, a patient, that seems to be forgotten.

For a patient, it is our problems, diagnosis & results, medication, Physician care, nursing care, our own patient (carer) delivered care. Then there is the problems associated with all of the above, our Allergies, and other complications.

Why have large Hospital Information Systems trying to talk to each other, when we could have a repository based on the patient. Use SnomedCT codes from one system into a patient personal health record system, and then feed this to other Hospital/Physician systems.
A person, the patient doesn't need detail, just high level information. Does a Physician/Doctor need 100% of the time every micro detail?
For extracting micro details this information could be linked to the SnomedCT code as an RTF PDF or similar documentation so the patient could if they wish read any detail (such as the patient discharge summary and other documentation).

The patient would then have control to share his/her data with anyone they need to.

If hospitals or physicians need further details they could manually extract any data they need from the RTF/PDF along with the SnomedCT codes. Gradually Hospital systems could automate the process if needed.

But the biggest problem I fear is the Healthcare Industry "letting go" of the patient information and empowering the person to look after their own data.

Yes we will need the tools to do this, in a simple format that we can understand, and probably have the automated tools to convert SnomedCT codes into information that we can use and add to. Yes it might not need to be Clinical terminology in English, for most of us have no degree in medicine or a PHD in C# let alone English as our native language. SnomedCT might not be the best code to use, but at least its a start.

The global population is growing up with IT, we are children no more, and we need to take responsibility of our records like we do our finances. Perhaps then patients may start to work with the Healthcare industry to fully understand and share the information. This might then help reduce the financial burdens we find ourselves in today.

It will not be cheap, it will be difficult to income generate focusing on the person, but think, if we the patient were recording some of our own care (Tramadol ETC) how clinically rich our data would be. It would bring a whole new meaning to exploring population health and research.
Yes, there are many barriers, there will be sceptics, and not all will want to share, but building on trust, transparency, changing the focus to the patients needs we might start this journey in "Sharing Electronic Medical Records".
ChrisMurphy
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ChrisMurphy,
User Rank: Author
6/17/2013 | 7:34:14 PM
re: Sharing Electronic Medical Records Still Too Hard
There's definitely something to this -- answering the question of what data as opposed to all data. But at least in this conversation, the participants greeted the notion of a personal health record that the patient controls with pretty universal skepticism because of the challenge of getting data into them, and the failure of such efforts to date. I compare it to personal finances -- most of us have our data spread out in lots of places (bank, 401k, investment funds, insurance), not consolidated in one place. Or is that only me that does that with their finances?
Harveyuk
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Harveyuk,
User Rank: Apprentice
6/17/2013 | 9:23:43 PM
re: Sharing Electronic Medical Records Still Too Hard
I think most people around the world will have our money in various places, our loose change in our pocket, an account for our monthly outgoings and if we are lucky others accounts to help on a rainy day.

But, we do have control of all our accounts to move our money around as needed.

In the healthcare industry, It is a bit like the UK Sterling Pounds and US Dollars, we can't use both together.

Hence the suggestion of the SnomedCT, it is one of the few universal healthcare currency that each system could convert to their own isolated coinage.

As patients, we do need to automate the process into a format that we can understand, a simple overview with detail as secondary data which current healthcare systems use.

To make health data friendly for patients we need to explore alternatives to words on screens.

I am not a company, I am not out to exploit and to make money, I have no commercial product to sell, but I share with you how I record my personal health data (An example only not my true record).
https://www.youtube.com/watch?...
ChrisMurphy
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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?
Harveyuk
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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!
cbabcock
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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
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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.)
slangpdx
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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.
jaysimmons
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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
anon4536176453
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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...
SusuE709
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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
Ivan Miller
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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.
cbabcock
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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.
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