Inability to share information across systems remains major EHR failure

Doctors have complained about EHRs’ inability to transmit and receive patient data for nearly as long as the technology itself has existed, and that shortcoming remains one of their chief criticisms. 

“None of the computers talk to each other,” says James Dunn, MD, an internist in a Muncie, Indiana, group practice and survey participant. “They’ve got so many different vendors out there and none of them have any kind of interface with each other.” 

Dunn, whose practice uses EHRs from InSync, says that while he is usually able to access patient information electronically at his local hospital system, “I have to go through about eight different steps to get there. It’s very frustrating.”

Adding to his frustration, he says, is that he tries to use Direct Messaging-a standardized protocol for exchanging clinical messages and attachments-and even has accounts both through InSync and the hospital system. But hardly any other providers communicate with him through the service. His own attempts at using the service to exchange information with other providers have met with only limited success, he adds.

As an employee of a large hospital system, Friedberg communicates mostly with  providers who are also using Epic. Even so, he says, he faces challenges when exchanging patient data. “Not everything ports over because not everybody has the exact same configuration,” he says. “So you might have a lot of custom stuff that doesn’t come over, or doesn’t fill into the right places in my EHR.” 

When one of Friedberg’s patients gets treatment from a physician outside of his system, even one that also uses Epic, “I get a notification that they’ve received care but I have to go through a bit of a rigmarole to actually see what happened,” he says.

Information from providers not on Epic-if it comes at all-is faxed, and then has to be scanned into his system. “It ends up in some part of the record where it can’t do any successful system support, with rare exceptions,” Friedberg says. “And the costs are prohibitive for actually getting the data elements into the system in a coded way.”

Poplin attributes the difficulty achieving interoperability to its low priority under the original Meaningful Use requirements. “All you had to do was a test with one other system, and it didn’t even have to be successful,” she points out. “Interoperability should be the first requirement, not the last.” 

Perhaps not surprisingly, Poplin’s experience as a physician in the military has left her pessimistic about the feasibility of interoperability. “I watched the defense department and  [Department of Veterans Affairs] struggle for 10 years to make their systems interoperable, and after all the money and time, they gave up,” she says. It shows how difficult it is once the systems are in place.”

Frantz (NextGen): As a healthcare company as well as healthcare consumers, we feel a tremendous responsibility to make sure our technology is truly interoperable, from a practice level approach, all the way up to a community-wide, complex system view.  We offer solutions for our ambulatory clients, many of them for free, that fully integrate into their workflows, allowing for secure, automated communications allowing physicians more time to deliver care.

For example, we were one of the first vendors to support the Carequality Interoperability Framework initiative, which allows for nationwide health information exchange of legal terms, policies and technical specs with other EHR vendor systems, such as SureScripts. The partnership with SureScripts enhances our interoperability efforts by enabling all connected users to share clinical information, such as text, CCDs, PDFs and other types of documents that are supported by the EHR vendor. With this comes the ease of not having to build one-to-one interfaces.

Mackie (athenahealth): Achieving true interoperability across different IT systems is more important than ever, particularly in the wake of natural disasters like hurricanes Harvey and Irma when it becomes critical that a patient’s chart follow the patient. It’s a tough reminder for the industry that we must be flexible and nimble enough to share patient data across different systems. Imagine if you had Verizon, and could only call people on Verizon’s network.

Dr. Friedberg points to a common misconception in the industry: Implementing the same IT system will facilitate seamless information sharing. Many EHRs are highly-customized, siloed servers that struggle to communicate with any external system (including those using the same vendor), or they communicate via point-to-point information sharing at great expense (e.g. HIEs).

This is why a cloud-based infrastructure is so critical for our nation’s healthcare industry. Too many doctors document care within disconnected software systems that aren’t wired for intelligence. They can’t tell you if a patient saw a specialist last month, had an out-of-network MRI for similar symptoms, or had an adverse reaction to a medicine prescribed by the orthopedist in the next town

athena’s cloud-based network is set up as a unified system; we exchange records and data across networks of hospitals, independent practices, labs, and pharmacies, which are pulled into and surfaced up within athena’s EHR workflow. (This also includes essential doctors’ notes.)

We were one of the first to activate clients on both CommonWell Health Alliance and Carequality to enable data exchange between various EHRs. We expect to be connected to nearly 100% of participating Epic systems via Carequality, and nearly half of Cerner systems via CommonWell by the end of 2017. So yes, connecting for better care delivery is happening. 

Cuthbert (MEDENT):): Everything being described is unfortunately very true. It is very disappointing, embarrassing and frustrating as a vendor to see how little we have accomplished so far in the real world setting.

This being said, we cannot give up and we need to double down to make much more progress. This would be a good role for the government to play a major part in by setting more aggressive requirements. Make it a true first priority, not a low priority. Require practices to hit much higher benchmarks.

Maybe creating a financial incentive system to get this accomplished will help. Vendors need to improve the design and not segregate direct messaging workflow.

Managers of practices should make this a bigger priority and insist that all their common trading partners use the technology. Naturally, something is bound to happen as more voices are heard.

The next generation of interoperability is around the corner and we all need to embrace it. Vendors should not be allowed to use its absence as a tool to protect market share. It will need to be the standard. The Fast Healthcare Interoperability Resource (FHIR) protocol will be revolutionary and we all need to get behind it.