EHR and Health IT Consulting
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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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Do Health IT Systems Need Greater Interoperability?

Do Health IT Systems Need Greater Interoperability? | EHR and Health IT Consulting |

The medical sector is aimed at reaching the triple aim of healthcare by incorporating health IT systems and EHR technology. The triple aim focuses on improving patient care, lowering medical costs, and boosting population health outcomes.

In a Health Affairs Blog, National Coordinator for Health IT Karen B. DeSalvo discusses the landscape of information technology in the medical space.  DeSalvo emphasizes the need for interoperability among health IT systems and mentioned how the Office of the National Coordinator for Health IT (ONC) is developing new implementation standards. Additionally, the need for privacy and security of patient data is also asserted by DeSalvo.

The sharing of patient data through health IT systems has been a major focus for the healthcare industry over the last year. To improve EHR interoperability, ONC has listened to the health IT community to develop a roadmap for establishing strategies and opportunities to move the country toward greater health data exchange.

DeSalvo has participated in many listening sessions across the country and learned about certain issues that harm the interoperability of health IT systems and plague hospitals and providers. Rural communities in Alabama, for instance, do not have full broadband access while bordering state privacy laws in New Jersey block medical data exchange. The overall essence of DeSalvo’s discussion revolves around the importance of interoperability among health IT systems.

“I also listened to my own experiences — as a doctor, as a daughter, and as a consumer,” DeSalvo stated. “I thought of countless patients whom I have seen and those I continue to see when I am in clinic. Of visits where I did not have the information needed to make a decision that day, requiring patients to return and miss work, school, or other obligations. Of patients who want to engage and feel empowered but need not only data, but information, to help them level the playing field, to allow them to meaningfully engage.”

“Of being a caregiver for a mother dying of dementia and being frustrated at just how hard it was to get access to the information I needed to help her. And, as a public health advocate and official, needing information about my community to prioritize resources to help them address the broad determinants of health,” said DeSalvo.

Over the last six years since the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed, the healthcare industry has gone forward with meeting many of the goals ONC established such as widespread implementation of EHRs and health IT systems. More and more eligible providers began meeting meaningful use requirements under the Medicare and Medicaid EHR Incentive Programs.

While these achievements are impressive, DeSalvo mentions the need to digitalize “the care experience across the entire care continuum” and gain “true interoperability.” ONC is currently working on a plan for both public and private sectors to gain interoperability. The next step for ONC and the healthcare industry is to go beyond meaningful use and EHR implementation in order to truly bring better health for patients across the country.

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What Has Hindered Progress toward EHR Interoperability?

What Has Hindered Progress toward EHR Interoperability? | EHR and Health IT Consulting |

EHR interoperability and the many forces working to promote interoperability of healthcare information are receiving a lot of attention these days. As well it should be!

It has been more than ten years since the Office of the National Coordinator for Health Information Technology (ONC) under the leadership of our first National Coordinator David Brailer, MD, published a seemingly straightforward four-step plan: implement EHRs, connect clinicians — remember regional health information organization (RHIOs)? — bring patients online, and enable population health.

Ten years and $30 billion of taxpayer funding later, we can report immense progress in EHR adoption, yet we are miles away from the ability to fluidly share patient records among providers and a partisan Congress wants to know the reasons. The $2 billion invested in health information exchange (HIE) startup grants has yielded very mixed results, with sustainable HIEs operational in few communities.

Many reasons can be cited for the limited progress — this list is not exhaustive.

For all the latest on interoperability in the healthcare inudstry, visit our new online publication

It isn’t that easy! The frequent comparison of healthcare information exchange to the ATM network greatly oversimplifies our challenge. Healthcare is a far more complex data model, and provider organizations vary widely across the country.

Stages 1 and Stage 2 Meaningful Use regulations include only limited interoperability goals. Hospitals and eligible providers attesting to meaningful use achieved those targets. Six years into the program most of the incentive funds have been received, only limited penalties remaining to further incent providers. Providers will surely weigh those penalties against the cost of Stage 3 Meaningful Use compliance.

Many of today’s standards are imprecisely defined, leaving room for flexibility in their interpretation by technology vendors and provider organizations. This has accommodated the structural differences among EHR products as well as the variation within and between provider organizations while leaving apples-to-apples comparisons across organizations difficult. The Continuity of Care Document (CCD) and the Consolidate CDA (C-CDA) standards in use for exchange across organizations are insufficiently granular to enable vendors to populate the EHR for convenient access and use by physicians.

Congressional restriction on exploring unique patient identifiers leaves us with various matching algorithms to identify and combine patient records across organizations. The best routines, including reconciliation by staff, are claimed to yield a 98-99% accuracy rate. Some organizations report mismatches in excess of 10%. Every mismatch becomes a patient safety issue, with either missing patient information or information incorrectly combined.

Organizations like HL7 and the Argonaut Project continue to advance the art and science of interoperability standards. CHIME recently announced a $1 million HeroX National Patient ID Challenge for the perfect patient matching solution. Both are essential to providing our physicians the information necessary for the best care they can give to their patients.

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