The Interoperability Issue: Making EMRs Play Well With Others

In an ideal world, a doctor could pull up a new patient’s entire health history within seconds. Everything would be available in the patient’s electronic record: allergies, prescriptions, prior conditions, notes from previous doctors, and more. Unfortunately, that’s not the reality. Take a random sampling of doctors, and you might find that each one uses a different electronic medical record (EMR) system, none of which are incompatible with each other. The electronic file that one doctor creates might be unreadable by a doctor on another system. Before our EMR utopia can come to pass, we have to solve this issue of interoperability.

Interoperability is one of the biggest barriers to the widespread adoption of EMRs. According to an article in Physicians Practice, several factors play into the problem: a lack of standardization among EMR products, vendors leery of sharing patients with the competition, programming languages that aren’t conducive to widespread use, and the inability of many EMRs to bend their data architecture to fit a competitor’s. Organizations such as the Certification Commission for Health Information Technology (CCHIT) have attempted to set forth some criteria for EHRs and EMRs, but at the moment, no unified standard exists. CCHIT is one of the organizations that applied for a spot with the Office of the National Coordinator for Health Information Technology (ONC), which plans to temporarily appoint three organizations to test and certify EHR systems. Ruling on a permanent certification program is expected in the fall. In the meantime, vendors are left waiting and wondering what to expect.

Peter McClennen, President of North America at interoperability provider dbMotion, says that we’ve already made significant progress in improving interoperability. “The industry is feeling the pressure both from a customer-demanding perspective and the federal government now pushing it.” McClennen believes that this pressure is ultimately positive for patients, providers and vendors, and that a vendor’s future survivability is in question if they can’t deliver interoperability. Companies such as Pittsburgh-based dbMotion are attempting to improve interoperability through product development and corporate initiatives. dbMotion’s platform is designed to work across a variety of external EMR systems. The platform is based upon service-oriented architecture, which uses software services to collect data in various formats, incorporate it into a single data object, and share it with users.

McClennen adds that while interoperability is important, so is aggregating the data and presenting it to the patient in a logical way. dbMotion worked with Google Health and the University of Pittsburgh Medical Center (UPMC) to create a virtual patient record that worked across various EMRs and could be accessed online by the patient. The company also partnered with UPMC to create an EHR application for BlackBerry smartphones.

dbMotion is also partnered with Chicago-based Allscripts. The two companies were selected this week to create a virtual health record for Thomas Jefferson University and Jefferson University Physicians. Allscripts has taken part in efforts including participation in the HIMSS annual interoperability showcase and a community exchange solution for the sharing of medical data. Allscripts Exchange utilizes a tool called the Universal Application Integrator, which allows the system to integrate applications that were created by a third party.

The NextGen Health Information Exchange (HIE) allows users to share data with other healthcare organizations, even if a participant is on a non-NextGen EHR system. The HIE acts as a central hub for sending and receiving clinical information. Providers can view patient data, process referrals, approve documents, and more.

Similarly, the MDinsight system from MDdatacor allows healthcare providers to share data across different systems. The system can pull information from transcripts, EMR notes and patient self-reported data. Data is compared to evidence-based guidelines to aid in clinical decision-making. Providers who don’t use an EMR system can still access MDinsight via a Web portal.

Let’s hear from you on the subject. What needs to happen for the barrier of interoperability to be removed? What’s your take on ONC’s impending certification program?

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