Jonathan Shoemaker was Featured on HIMSS News
Perspective On: EHRs' Achilles Heel in Pursuit of Interoperability
There is a climate of frenetic activity surrounding today's EHR market that is masking some obvious issues. The positive aspect of the activity is that the process of EHR determination, selection and installation will create thousands of jobs and a supporting infrastructure in healthcare that currently did not exist. The future challenges will emerge when all of these new digital silos must talk to each other as required in Phase 2 of meaningful use. It is the very selling point of these systems – simple communication and usability – which become the Achilles heel of these EHRs.
To date, EHRs are not installed with a common code structure for identifying exams, studies or services, all of which will need to be exchanged outside of the office in Phase 2 of MU. The reason for this lack of standardization has nothing to do with EHR functionality or capability — it is that everyone is still thinking locally not globally.
To ensure true interoperability and exchange of patient health information, EHRs must be installed to satisfy the local requirements and with the forethought they will integrate to larger systems (both within and outside of your enterprise). This requires standards and standardization. The absence of a standard will require the use of translation services so that health information exchange repositories use the same codes for exams performed across the region.
Once all of the paper silos are replaced by digital silos, there will be enlightenment of EHRs that were:
installed incorrectly,
don't address the clinical workflows of the office, and
don't communicate outside of the office with a standard communication protocol using standard coding methods.
This will lead to a second phase of the EHR revolution, which will include translation services and reinstallation of EHRs to address workflow and data gaps. This will have to be resolved before integration to a larger HIE repository can take place.
We risk losing users' confidence with our current strategy of "every man/woman for him/herself," once these systems are installed and address workflow and physician concerns. Once we lose the users' confidence, they will stop using the system and re-adoption efforts will prove Herculean.
As you begin planning your EHR implementation, there are hundreds of questions to ask. When it comes to meeting the long-term requirements of meaningful use as well as realization of the true benefits of an EHR, here are a few to begin with:
Have we reviewed and documented our office workflow?
Are we using the new SNOMED codes?
Are we following standardized codes for services rendered?
Does the installation team understand clinical workflow or do they look glassy-eyed when we discuss medical terms?
Is our vendor of choice an IT company trying to cash in on the health IT initiative without clinical experience and knowledge which could place our business at risk?
How will this EHR connect us in the future to larger integrated systems?
Jonathan Shoemaker is a Senior Consultant at Ascendian Healthcare Consulting.
