For years, we have all been promised interconnected electronic patient records – the concept that information would follow patients and be available across all care settings. Unfortunately, this reality has yet to materialize.
Regional Health Information Organizations (RHIOs) exist all over (these are hospitals, physician practices, and health networks that exchange data on a local level), but they typically present a "brick wall" at their borders where the information sharing stops. Thankfully, that is poised to change, with a new push toward meaningful interconnectedness.
Finally, health information technology (HIT) thought leaders and electronic health records (EHR) vendors are homing in on standards that will allow physicians and other healthcare providers to exchange information seamlessly regardless of EHR system or geographical location. The goal, as usual, is to improve patient care and outcomes. In this column, we felt it would be useful to highlight some of the ideas driving this effort, as there is good reason to be optimistic about the possibility of true interoperability.
A view from the top
Recently, at the annual meeting of the Health Information Management Systems Society (HIMSS) in Orlando, Dr. Karen DeSalvo, national health IT coordinator, made a strong plea for interoperability by 2017. She said "We can do national health care exchange in 3 years. ... I want this as a doctor, I want this as patient, I want this as a daughter."
Dr. DeSalvo’s words resonate because this is a concept we all expected from the earliest days of electronic records. Unfortunately, barriers – both real and artificial – have stood in the way. First and foremost are patient privacy and information security. It is essential that patient data are protected and maintained as the data pass from one system to the next, but often, even the basic function of matching patients with the right records can be challenging. Many identifiers exist, including various medical record numbers and insurance codes. If a name is misspelled or middle initial omitted, this can also create significant chaos and allow sensitive data to file into the wrong place, creating HIPAA violations and distrust among patients.
In addition to concerns over data security, the lack of standard formatting for storing and sharing records has been a huge hurdle for EHR vendors. Not surprisingly, the simultaneous development of dozens of competing EHR products has created significant fragmentation throughout the market. Instead of starting from a common set of data elements, each EHR was essentially designed "in a vacuum," and only now are their creators attempting to find a way to get them to communicate. A number of cross-platform projects currently underway highlight this effort.
VHS or Betamax?
On Feb. 25, 2014, NextGen Healthcare and Cerner announced bilateral certification of their EHR products and affirmed their commitment to interoperability. According to the press release, they are committed to "creating proactive working relationships, expanding the boundaries of current interoperability ... and supporting the efforts of [their] clients to advance the health of their communities." These may not be novel goals, but at least both vendors have demonstrated their best attempt to achieve them. Also, both companies have a huge footprint in the market, so their collaboration is certain to raise the level of attention being paid to this topic. But this isn’t the only attempt at broad-based interoperability.
EClinicalWorks (eCW), another large player in the ambulatory EHR market, has developed a product know as P2P, or Provider to Provider. Originally conceived as a way to communicate between different users of the eCW platform, it has now been expanded to all providers, regardless of their EHR, as a secure communication tool. This new product is known as P2POpen and is free to any health care professional wishing to join "the network." According to their website, P2POpen now boasts close to 22,000 users and facilitates "improved quality, safety, and efficiency of care." Like the collaboration mentioned above, P2POpen has a shot at success, but both of these efforts may also portend more debate over standardization moving forward. Will the disparity in how each company addresses the issue of interoperability lead to further fragmentation? And how can we be sure that embracing one of these ideas won’t severely limit us in the future?
Setting the standard
The only way to answer these and other looming concerns over developing a consistent interoperability protocol is to start at the top and rapidly build consensus. In other words, Dr. DeSalvo’s words need to be quickly translated into action, as she and other thought leaders agree – not only on a standard – but also on a way to properly motivate EHR vendors to adopt that standard.