The EHRs is made of series of disparate systems built in silos that are suddenly being asked to work together for the good patient care. And the ability of different information systems and software applications to communicate, exchange data and use the information exchanged is interoperability. The practices want to achieve full interoperability and pave the way for the future learning health system.
If not number one priority, interoperability is among the top priority for the US policy and health IT in both public and private sectors. Interoperability is easily considered as the ‘secret ingredient’ for the successful value-based care models. True interoperability is supposed to:
- Convey giant C-CDA documents from one EHR to another
- More theoretical connections between systems that are prevented from connecting to the practice
- More than just combining clinical data with more clinical data
- The aim is to develop infrastructure that provides broadest reach, geographically and the number of healthcare providers and entities that can connect for data exchange.
The Objective is to:
- Improve patient access
- To minimize the extra effort by the providers
- Serve workflows and use cases of everyone in the enterprise
- Facilitate secure, electronic movement and use of health information
- Minimize special effort on the part of the provider
- Serve workflows
- Minimize point-to-point connections and exchange agreements
- Avoid ‘information blocking’
But while accomplishing this there are some real challenges faced such as:
When it comes to interoperability, it is difficult to locate and access records. Therefore, a viable Record Locator has the ability to efficiently discover where a patient’s data can be found and provides the electronic address to enable end-to-end communication. The record locator is stored in different EHRs among numerous care providers. Even in a broad network or highly saturated network of health care providers, there still remains the challenge of knowing where to look for or whom to ask for records. When it comes to HIPPA, it permits the healthcare providers to give patients the choice as to whether their health information is available for treatment or payment etc.; but it is not compulsory to do so. This Uniform Consent always gives the patient a choice.
As almost all the communication takes place digitally, the consent and data sharing in some states is given to a specific provider for accessing health records and sharing it with other providers. In other states the consent is given to every patient to automatically opt-in to HIE operations. When it comes to Consistency of standards, each interface needs specific implementation of the standard even though HL7 is universally used. There is lot of expense and other maintenance challenges faced due to this inconsistency. Across the interoperability landscape there is uniformity (Meaningful Use) that helps bring abundance of technology standards.
Cybersecurity is also one of the challenges as the EHRs mature and collects huge amount of data. It is overwhelming for the staff to manage the workflows. To overcome this challenge, it is important to educate staff on the proper use of hospital/practice management systems; training, documentation, placing safeguards within EHRs and support for digital innovation. To successfully gain the complete picture of a patient, the systems need to be in sync with one another. In other words, data must be available and must be transferred seamlessly from one source to the other to help in patient diagnosis and outcomes.
In the age of mergers and acquisitions, there is more emphasis on value-based care in the healthcare reimbursement that has impact on the EHRs. For example, the organizations that offer precision medicine face a challenge as the data that includes family history and DNA tests can tailor the treatment and improve patient outcomes. The focus gets shifted, when some EHRs are cumbersome and still use the features driven toward reimbursement for which they are developed.
A hybrid IT environment made of combination of cloud and on-premises is needed. Technology and strategies exist to assist these challenges. Whether there is attempt to accomplish meaningful use or improve the overall care of our patients, there is a necessity to improve functional interoperability. The EHR systems must be open to accept data from other resources and different settings. It should be able to use data collected in daily living settings.
The smart phone has changed our behavior, sometimes for better, as we are connected and are engaged with more people than before. The loss of a smartphone can cause anxiety disorder, in same way lack of interoperability causes fatigue in the providers and other personals related to the practice. But hopefully there is a cure that is not too distant, because living in a world of health record interoperability just as prolific as smartphones and there is no going back.
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