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?

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.

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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...
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