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How Business Decisions Challenge EHR Integration Efforts?

EHR integration on the front lines reveal that business decisions rather than technical limitations are holding back advances in information sharing.

By Kyle Murphy, PhD

- Over the past year, federal officials have grown increasingly interested the ability for healthcare organizations and providers to share information through the use of interoperable EHR technology, which has raised the need for EHR integration.

EHR integration challenges center on non-technical aspects.

But despite all the focus on technology and functionality, misconceptions remain and continue to prove detrimental to advancing interoperability and health information exchange.

"One misconception surrounding EHR integration efforts is that the larger issues are technical in nature, when in fact they’re actually related to information architecture and workflows," Arcadia Healthcare Solutions CTO Jon Cook tells EHRIntelligence.com.

"For a long time in the technical field, we’ve known how to exchange data," he continues. "The challenge lies in whether or not the EHR vendor will permit the exchange of data, and if so, if the data is in a format that the receiver is able to understand and use. There’s been a lot of discussion surrounding transfer protocol, semantics and structure in the last handful of years, and these still remain a major issue."

Much is due to federal programs such as meaningful use for help mitigating the technical challenges associated with information sharing.

"Whether you love it or you hate it, meaningful use has shined a spotlight on integration issues. As health IT standards progress, we’ve seen vendors becoming much more willing to participate in the open exchange of data," Cook adds.

A byproduct of this maturation in health IT standards and EHR design is the growing demand among providers for more convenient approaches to health data exchange.

"Providers are now pounding their fists and rightfully expecting data exchange, and things are better than it ever has been in terms of integration. Despite this, there’s still a ways to go," says Cook.

In its most recent report to Congress, the Office of the National Coordinator for Health Information Technology (ONC) provided details about the barriers in the way of integrating health IT infrastructure across the country. One is a lack of information about the capabilities of health IT products, particularly functionalities related to information sharing.

In particular, providers cannot effectively compare solutions and select those that meet their needs when they lack access to basic information about the costs, limitations, and trade-offs of competing health IT products and services. This includes capabilities that will enable them to participate in new care delivery and payment models that leverage health information exchange and analytics. In addition, providers are more likely to become “locked in” to technologies, which diminishes incentives and opportunities for health IT developers to improve their technologies and compete to deliver more innovative, more advanced, and less expensive products and services that meet the needs of providers, patients, and the health care system.

Such is the reality that Cook and other EHR integrators encounter in their effort to support providers and the fluidity of their EHR data.

"While EHR vendors may say they have the ability to exchange data, we often find that all the data is not where vendors think it is. They’re unable to exchange data they don’t know is missing, therefore we’re seeing significant gaps in the data," he claims.

Only so much blame can be laid at the feet of EHR vendors and the health IT development community more widely. In their design to support clinical workflows, healthcare organizations and providers often make the decision to customize their EHR technology, which can have consequences for EHR integration efforts.

"Everyone wants to customize their system, but eventually they’ll need to integrate that system with something else," Cook explains. "With more customization, it becomes harder to integrate down the road. Providers are now more aware than they’ve ever been of the potential issues that come with customization, but it’s important end users keep this in mind as they build out their workflows."

So is it the case that technology is taking the blame instead of business decisions? The national dialogue appears to be trending toward the latter.

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