Sharing Electronic Medical Records Still Too Hard - InformationWeek

InformationWeek is part of the Informa Tech Division of Informa PLC

This site is operated by a business or businesses owned by Informa PLC and all copyright resides with them.Informa PLC's registered office is 5 Howick Place, London SW1P 1WG. Registered in England and Wales. Number 8860726.

Healthcare // Analytics
04:27 PM
Chris Murphy
Chris Murphy
Connect Directly

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.

We welcome your comments on this topic on our social media channels, or [contact us directly] with questions about the site.
1 of 2
Comment  | 
Print  | 
More Insights
Newest First  |  Oldest First  |  Threaded View
<<   <   Page 2 / 2
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).
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?
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".
<<   <   Page 2 / 2
What Digital Transformation Is (And Isn't)
Cynthia Harvey, Freelance Journalist, InformationWeek,  12/4/2019
Watch Out for New Barriers to Faster Software Development
Lisa Morgan, Freelance Writer,  12/3/2019
If DevOps Is So Awesome, Why Is Your Initiative Failing?
Guest Commentary, Guest Commentary,  12/2/2019
White Papers
Register for InformationWeek Newsletters
Current Issue
The Cloud Gets Ready for the 20's
This IT Trend Report explores how cloud computing is being shaped for the next phase in its maturation. It will help enterprise IT decision makers and business leaders understand some of the key trends reflected emerging cloud concepts and technologies, and in enterprise cloud usage patterns. Get it today!
Flash Poll