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Interoperability needs rapid progress in 2017

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Making progress on interoperability will remain one of the main themes for 2017 within the healthcare IT industry. The reasons are many and, simply put, it’s time, people.

We all laugh at those good ol’ days, when a fax machine could only send and receive blurry copies from people who had the same model of fax machine (yes, I’m that old; we used ‘em in our newsroom in the late 1970s). The sad irony is, we’re making snail’s progress in moving beyond that reality with electronic health records.

The use of EHRs has achieved penetration among healthcare providers that, 10 years ago, seemed unlikely. More than 95 percent of all hospitals have them in place, and nearly 80 percent of eligible professionals are using them.

Those are heady percentages indeed. But despite the rush to digitization of medical records, there’s still a sense that it hasn’t enabled significant improvement in medical care, at least not of the magnitude of the hundreds of billions spent on EHR systems in the past 10 years.

Part of the fault lies in the systems themselves, a topic I plan to explore a bit tomorrow.

A bellwether 2013 study by the Rand Corp. for the American Medical Association found general physician dissatisfaction with EHRs, and a study reported this year by the Mayo Clinic and the AMA showed little improvement over the past three years. A key finding in the most recent Mayo-AMA study was that 62.5 percent of respondents said EHRs did not make them more efficient.

Also See: EHR, CPOE use linked to physician burnout and dissatisfaction

There are many reasons behind that inefficiency, but interoperability is at least the easiest starting point in addressing the difficulties. Improving the ability, ease and willingness to exchange information would make lives easier for physicians, hospitals, administrators, pharmacists, post-acute care providers—you know, pretty much everyone in the care continuum.

The ability to transfer information easily between members of a patient’s care team, at a simple level, at least offers the chance to improve efficiency by taking some of the needless and crazy manual handoffs out of the equation. If specialist A could review notes from primary care physician B at the right point in workflow, consistently, with salient information at his fingertips, that at least offers a chance of improving efficiency. Ditto on communicating what happened in patient encounter with specialist A, back to primary care physician B. Throw a bunch more clinicians in, with letters C through Z as identifiers, and you see how easy information exchange could bring a multitude of benefits.

That’s what the Dept. of Health and Human Services is trying to facilitate, starting at last year’s HIMSS conference, announcing that vendors, providers and professional associations had committed to sharing basic clinical information with patients and each other, and not participating in information blocking. The recent passage of the 21st Century Cures Act steps it up a notch in terms of requiring progress on nationwide interoperability and disdaining information blocking.

Let’s face it—EHRs that don’t really exchange information are going to be an anchor that drags providers down in accomplishing what they need to achieve under value-based care. Lack of communication is going to cost them money.

And beyond that, poor communication costs patients their lives. We all know that—in fact, it’s probably happened to each one of us in our personal lives. My father passed away in a hospital 15 years ago, choking on his secretions, due in part to profoundly poor handoffs between providers. X-rays of his lungs taken on Sunday at an outpatient facility were propped on a radiator in his hospital room, as hospital staff tried to treat him without the benefit of seeing those images. It is a scenario that should never happen in this day and age, but how many thousands could receive better care—true care unto health—if we could just hand information off between professionals?

It is time to weep when we consider that taping a CD of a patient’s images to his or her chest during a patient transfer is the best way to exchange medical information, in this day and age of computerization.

And we must commit to building upon simple exchange of information that’s merely readable to some way to enable its access and incorporation into the medical record system of the receiving provider, so that it’s available within clinicians’ workflow, without a lot of extraneous notes that add little to the exchange of information (or that merely hide the existence of critical information in massive amounts of verbiage).

There’s growing momentum to achieve interoperability, and that’s something that those advancing the cause can be proud of. But as White Sox commentator Ken Harrelson often says after the team scores a run, “Don’t stop now, boys.” Settling for a single run isn’t enough when the industry truly needs a very big inning to get back in the game.


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