Many health care systems are increasingly turning to electronic health records (EHRs) these days as they attempt to streamline the care that they provide, while also simplifying processes for care providers as well as patients. However, EHR interoperability is often not as effective as it could be. Instead, some systems turn health care communications and data transfer into an enormous headache for all involved. By learning more about EHR interoperability and working on ways to improve it, health care systems can smooth out frequent communication channels, improve overall patient satisfaction, and even reduce common costs associated with care.
Numerous providers and health care facilities currently use EHRs. In fact, the Office of the National Coordinator for Health Information Technology reported in 2017 that 86% of office-based physicians used EHRs. The office also reported that as of 2015, more than 80% of non-federal acute care hospitals used EHRs that included clinician documentation. With EHRs used so frequently across the country, it is important to understand what they are and how improved EHR interoperability can benefit the bottom line for any practice.
What Is an EHR?
EHR stands for electronic health record, and it is a method of conveniently and securely storing a patient’s complete health record digitally. The EHR replaces the traditional paper chart. It provides information along with an ability to access patients’ prior medical histories, test results, and much more. Unlike the electronic medical record (EMR), which focuses solely on the medical history and treatments of a patient, the EHR goes beyond this by including all aspects of patient care.
Specifically, the EHR is designed to be shareable with other organizations or providers to create the highest level of continuity of care possible. Therefore, a high-quality EHR can travel with a patient should he move to a new state, change health care systems, or transition into a long-term nursing facility. In addition, an EHR can be accessed by the patient so that the individual can take an active role in his or her care plan.
What Is EHR Interoperability?
Interoperability refers to a system that can easily be integrated with another system to share important information. With an EHR, interoperability refers to the ease with which medical records and health care information can be transferred from one provider or system to another. While health care systems do have a variety of ways in which they can communicate with each other, the EHR is usually seen as one of the easiest and most secure options that do not create information blocking.
According to the Office of the National Coordinator for Health Information Technology (ONC), EHR must have four key areas of technology successfully integrated to be considered completely interoperable. These include:
- Application interaction with users
- System communication
- Information processing and management
- Consumer device integration
In other words, the EHR must communicate well with others, including clinicians, pharmacists, and patients in the comfort of their own homes. This allows health care information to be accessed quickly by the right people yet is barred from those who do not need it.
Three Levels of Health Information Technology Interoperability
The United States government has created standards of EHR interoperability to improve communication among different health care systems and EHR technology types. In 2013, the Healthcare Information and Management Systems Society (HIMSS) board defined the three key levels of EHR interoperability that allow systems to access data, exchange information, integrate new data, and coordinate care with a multitude of other practitioners even across organizational, state, and national lines. It is important that organizations focus on all levels to provide the best quality of care and the highest level of security when it comes to private health information.
While each of the three following levels of interoperability are clearly important, all must function together equally to create the most accurate and meaningful databases of patient information.
1. Foundational Interoperability
First, it is vital for the EHR to have foundational interoperability. This allows the system as a whole to give data to another system while also receiving data. While the data being received does not need to be interpreted as a part of this level of interoperability, it will be immediately available within the system. This is the lowest functional interoperability level and only allows for the most basic level of data exchange.
2. Structural Interoperability
Second, the EHR must feature structural interoperability, meaning that the data can pass through the system correctly so that providers are able to clearly see unaltered patient data. This intermediate area of health care data exchange ensures that patient information is sent and received in a meaningful and shareable format to create a new EHR database using structured messages. In addition, information and meanings will not change even though the data may change hands.
3. Semantic Interoperability
Third, the EHR must also have semantic interoperability, which allows the data to be restructured and codified correctly so that each system can correctly receive and understand the new data. This means that the language from one EHR system must be able to be read correctly by the new system. Of course, this is the highest possible level of interoperability, and it can greatly affect not only patients and providers in a health system but also scientists and researchers who are gathering data to study patient populations. At this level, information not only is exchanged but also is able to be used due to the use of standardized coding.
Importance of Interoperability
Much as it is vital to speak the same language as someone else you are speaking with, it is equally important that EHR systems be able to communicate with each other using standardized vocabulary that can easily be interpreted. This ensures that patient data stays accurate, decreases the amount of time spent searching for paperwork during patient appointments, and even creates better health care outcomes.
EHRs Must Be Able to Share Information
The most important feature that an EHR system brings to any health care organization is its ability to communicate data to others who have the need to access it. If the system is not interoperable, this benefit is lost entirely. EHRs were originally designed to coordinate care among providers, to help patients experience a higher quality of care, and ultimately to lower health care costs for patients and organizations.
Of course, not every type of EHR will work for every health care system. While there are a few primary players today, health care organizations typically choose EHR vendors that best meet their needs based on patient populations, ease of use, and budgetary constraints. Because of this, EHR systems must be interoperable in order to share information between them.
Improved communication is a key benefit of improved interoperability as different systems must be able to talk to each other for the best results. If systems are not interoperable, when data is sent from one system to another, it will not be able to decode the information to create meaningful patient data. With the three interoperability standards that are in place in the United States today, many EHR vendors ensure that high-quality communication between systems is a priority.
Despite these standards, however, numerous vendors still choose to leave things murky. When this happens, providers must rely on older communication methods including faxing and even paper documentation, to transfer patient data from place to place. At most hospitals, a provider will need to use more than a dozen EHR systems just to get a full database of information for many of their patients.
If EHR systems were completely interoperable, this poor communication would change entirely. Instead, both patients and providers would have easy access to vital health care information, helping to improve health care outcomes across the board.
Barriers to Interoperability
Thanks to the numerous EHR systems in use today, interoperability remains an illusion for many. Every EHR system has a different interface and ability to accomplish a myriad of tasks. Systems speak in different coding languages and use different vocabulary, making the task of transferring this information incredibly complicated.
Aside from these problems, it can also be financially difficult to improve interoperability. Creating new connections between systems can be expensive. In some instances, IT companies receive incentives to keep communication between systems low. This may be to preserve a company’s information or to ensure that health care organizations have to continue purchasing programs from numerous EHR vendors rather than from only one. Of course, the ongoing concerns over patient privacy make the matter even murkier, as it can be difficult for companies to know what information can be safely and legally sent to another system.
Whether a healthcare organization is large or small, improving EHR interoperability is a major project that requires the support of many people before it can be fully integrated.
Benefits of Interoperability
Even a cursory examination of EHR interoperability will quickly prove that it comes with a myriad of benefits for patients, providers, administrators, and even financial stakeholders.
1. Provider Benefits
For years, clinicians have experienced delays in receiving patients' paper records or results, therefore delaying or hindering their ability to see the full picture and finalize accurate diagnoses and treatment plans. With interoperable EHR systems, providers have immediate access to readable health care data, allowing them to treat patients with a minimum of errors related to lack of access to data. This could even reduce the number of lawsuits that these professionals face each year.
2. Patient Benefits
Patients also benefit from knowing that their health care records are complete and accurate and can follow them wherever they go. Whether they move across town or around the country, a new provider will immediately be able to see their medical history. In some cases, increased speed in data dissemination can create very real benefits to an individual’s health thanks to faster treatments and decreased testing needs.
3. Cost Benefits
There are a variety of ways that health care organizations can save money after investing in an interoperable EHR system. First, they would not have to pay for as many malpractice suits as providers will be able to provide a higher level of care to all patients. Second, they will also be able to make more money as providers will have more time to see higher numbers of patients once they are no longer spending valuable time sifting through paper records. Third, some testing and procedures could be eliminated because providers will be able to provide more accurate care after seeing that testing has already been done in the past.
In any industry, interoperability refers to how well various computers and software systems are able to communicate among themselves, sending and interpreting all types of data.
In the health care industry, EHR interoperability is vital for improving patient care and outcomes, enhancing the workplace environment for providers, and saving money for the health care organization at large.
Interoperability ensures that patient data is shared accurately among providers and organizations, improving efficiency, decreasing unnecessary diagnostic testing, and improving communication between referring doctors and specialists.