The push to use electronic health records (EHRs) through a certified vendor before 2014 has healthcare providers, hospitals, and similar organizations scrambling to meet new definitions of interoperability and meaningful use. But even with the new standards, it may take much longer for EHR technology and functionality to become ubiquitous in the healthcare industry. By Rob Sabo
By Rob Sabo
The push to use electronic health records (EHRs) through a certified vendor before 2014 has healthcare providers, hospitals, and similar organizations scrambling to meet new definitions of interoperability and meaningful use. But even with the new standards, it may take much longer for EHR technology and functionality to become ubiquitous in the healthcare industry.
HealthIT.gov, the federally run web site dedicated to advancing standards in health information technology, identifies four main issues with EHRs and interoperability, or the ability of patients' EHRs to be accessed from different healthcare providers, hospitals, insurance providers, and consumers. Those issues include:
How EHR applications interact with users
Ways different EHR systems communicate
How information is managed and processed
Ways consumer devices access EHR systems and applications
Here's a closer look at the issues surrounding the transportation of patient information, workflow procedures, and industry standardization of EHRs.
EHRs and standardization
Micky Tripathi, president and CEO, Massachusetts eHealth Collaborative, says the U.S. healthcare system is among the most fragmented businesses in the country, both on the supply and demand side. It's the direct opposite, Tripathi says, of the banking or airline industries – ATMs all work the same, and the airline ticket reservation process has the same standards no matter where you book tickets.
And there's only one player in the healthcare large enough to affect change, Tripathi says. "In other industries, where you have economies of scale and scope, there are large standards being diffused across the industry, usually by large or a large set of players. It's really hard for that to happen in healthcare."
According to Tripathi, the key for standardization of EHRs is getting the one organization that can affect the entire healthcare industry – Medicare/Medicaid – to require standardization of EHRs. Medicare and Medicaid can bring about industry standardization by ensuring their service providers are all on the same technological level.
"You can see it as Medicare investing in its supply chain providers by saying, 'You aren't at the technology level you need to be at to run our business.' Once we start to get that, we will standardize the way providers do things within the Medicare network, and it will make those businesses better and more efficient.”
EHR workflow procedures
Laura Rappleye, interoperability project lead, Altarum Institute, a nonprofit that manages the Michigan Center for Effective IT Adoption, says one big problem with EHR technology and using it in a meaningful way is the changing workflows and roles EHRs create within physicians’ offices.
For instance, the person who normally faxes lab results and inputs that information into electronic medical records (EMRs) is not the same person who views the electronic results of that lab specimen. In many physicians' offices, Rappleye says, workflow procedures and roles are changing. That fact, coupled with a rush to bring aboard EHR providers that meet 2014 certification standards, can interrupt the flow and quality of care in physician offices.
The Altarum Institute trains medical service providers in Six Sigma lean technologies to increase office productivity and efficient use of EHRs. "They are busy treating patients, and it's helpful to have someone go in and provide lean process optimization," Rappleye says. "We are in the trenches helping on workflow redesign using lean processes that can benefit providers."
EHR transportation and delivery
Currently, there is no standardization of the way information on EHRs is delivered and viewed. Tripathi likens future delivery of EHRs to letters delivered by the U.S. Postal Service.
What's needed, Tripathi says, is a format similar to a U.S. letter post – everyone knows where the stamp, address, and return address go and the language inside a formal letter is formatted properly with a date, heading, body, and closing statement. Lastly, the letter must have the same semantics – for example, it's written in English so that everyone understands the language. "That's what meaningful use is starting to do by trying to attack all three of those things," Tripathi says.
The solution for industry-wide EHR transportation and delivery is to define a transport standard and content format, as well as standardizing the way EHRs are codified, or the language they contain. It does no good if a physician's office on one side of town can't read EMRs from a lab across town because the two organizations use different lab codes for the same procedure.
"It will take a lot of time for the industry to effect this change, but at least the issues are identified," Tripathi says. "We are just at very beginning for health interoperability. We are kind of where phone systems were in the early 1900s when there was something like 2,000 independent phone networks in the U.S."
The healthcare industry won't take most of this century to adopt industry-wide standards, though. Things happen blindingly fast in the field of information technology, and patients expect more from EHRs than ever before. Those two factors could drive widespread use of EHRs throughout the industry and the creation of patient portals where consumers can easily access standardized electronic medical records.
About the author
Rob Sabo writes about education, technology and healthcare for a variety of print and online publications, including AlliedHealthWorld.