5 Reasons Why A Single, Integrated EHR Will Not Solve Interoperability

5 Reasons Why A Single, Integrated EHR Will Not Solve Interoperability

A recent survey of health system IT, informatics, business, and clinical staff revealed that less than 40% of healthcare executives believe their organizations successfully share clinical data with external health systems, payers, and other partners. When asked what steps their organizations are taking to address interoperability challenges, 60% of respondents reported their organizations were moving to a single, integrated EHR. In addition to costing tens or hundreds of millions of dollars, changing EHRs to homogenize across a system does not solve the myriad challenges that stand in the way of seamless data exchange—neither within an organization nor with outside entities. Consider the following reasons why moving to a single EHR will not remove all barriers to achieving true interoperability in healthcare:

1. Associated small practices are unlikely to change

Moving to a single system does indeed make information easier to share from a technical perspective. The EHR market has some big players, particularly in the hospital market. So, expanding the use of Epic or Cerner within a hospital system makes sense from an IT and change management perspective. But among physician practices of 1-3 doctors, 14.40% use Epic, 10.56% use eCW, and after that, market share drops to single digits. CMS reports that 30% of physicians use systems from small vendors or ones that are self-developed.

And these smaller practices are least likely to change and least able to afford to do so. Trying to solve the issue of interoperability by making everyone move to a single EHR across a network of both employed and associated physicians is simply not practical given the cost and disruption it would cause.

2. There are several ways to code within the same EHR

Health systems that have the same EHR may be using different code systems or medical annotations for the same clinical concept. For example, consider “Glycohemoglobin” or “Glycolated Hgba1c” versus “HbA1c” and its associated LOINC code 4548-4. A business partner recently reported that during a consulting engagement with a hospital system that had implemented a single EHR, the CMIO reported to her that he had identified 18 different codes to document a mammogram. Her analysis uncovered 123 different codes within that same health system.

3. Different providers document differently

How individual users document clinical care adds even more variation. One clinician might document an entire episode including diagnosis and treatment by typing a narrative into a note. Another might dutifully input information into structured data fields or select from a pulldown menu displaying discrete choices. Even if structural interoperability ensued (that is, the information could be interpreted at the data field level), if a field is empty, no relevant history is transferred.

4. Semantic interoperability remains elusive

Just because I can open a document doesn’t mean I – or a software system – can understand it, as there is more to exchanging knowledge than simply being able to open a file. Although human beings can often read between the lines, software systems have limited or no ability for interpretation. Interoperability is limited by common issues in clinical documentation.

These include the use of local versus standard terminology libraries; entering free text instead of capturing data in structured fields; and mistakes such as using the wrong unit of measure such as a percentage instead of a count. These variations that limit downstream use by both software and human users all need to be accounted for in our interoperability strategies. This is a fundamental issue that moving to one EHR won’t solve.

5. The entire ecosystem cannot be overlooked

Another consideration is that interoperability solutions should support healthcare processes beyond the single-use case of care coordination among clinicians. This requires accepting data from pharmacy systems and other parts of the supply chain, and communicating information captured at the point of care with disease registries, clinical trial systems and more. Adopting a single EHR will not help with interoperability across this broader ecosystem of systems and applications.

Physicians will continue to document as they will, and different institutions and individuals will pick the software they want, as well they should.  As healthcare IT vendors and service providers, it’s our job to instead adopt open standards that seamlessly translate from one system to the next. Homogeneity is not a long-term solution to fluidity and flexibility in the exchange of clinical information across the healthcare ecosystem. Continual work behind the scenes to liberate data from proprietary systems – not lock it down – is what we owe healthcare stakeholders.

About Kimberly Howland, Ph.D.  is Chief Product Officer at Diameter Health, the leader in normalization, cleansing, deduplication and enrichment of clinical data from across the care continuum.

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This is where Health Information Exchanges fit in. Electronic Health Records come in many different sizes and colors. Small and medium-sized health care providers use a different set of EHR than do large health systems, such as EPIC, or CERNER.

The original goal as set forth in 2005-2006 was to set interoperability standards, designed by the Office of the National Coordinator for Health Information Technology (ONCHIT). The new office was placed in the Executive Branch reporting to then-President George W. Bush.  This took place as information technology was exponentially rising, and Health Information Technology was only one part of Federal, State, and local governments invested enormous sums of money and time to outline a plan.  Many volunteers from industry, health care, think-tanks collaborated.  Most early information exchanges withered on the vine despite substantial grants from the government.  "All grant money eventually ends" (Levin's 1st law of HIT)  Levin's 2nd law of HIT followed soon, "All things change"

In the beginning, there was no light, neither were there EHRs or HIEs. The people (providers, hospitals, and others) were not created equal nor in the image of the creator.  They knew not the language (acronyms)



The health system was split asunder and cast out, each with their own language as if in Babylon. There was a great deal of babble then and now. Fortunately, there are only 26 letters in the alphabet, and acronyms became confusing, redundant and unintelligible.

It was an Epic Battle

AWS or AWS is offering. ‘Interoperability Land’  Not only has Amazon expanded into the retail pharmacy space purchasing 'PillPack.  AWS is offering a cloud space as a 'virtual sandbox' for developers of interoperable software platforms.  For those of you familiar with Github it is a very similar site for developers to practice their code simulations.  By clicking on the Interoperability Land you will be taken to the AWS subscription page.

5 Reasons Why A Single, Integrated EHR Will Not Solve Interoperability:

Report: Most Health Systems Still Lack Long-Term Digital Strategy

The Health Care "Manhattan Project" (NOT)

Healthcare’s digital transformation is still in the early stages of maturity relative to other sectors, but CIOs do understand the imperative to drive digitalization, according to a new report from advisory firm Damo Consulting.

The report’s findings were revealed in focus group discussions with nearly 40 CIOs and senior health IT leaders who are members of the College of Health Information Management Executives (CHIME). When asked to define digital transformation in healthcare, 60 percent of respondents said it is about using digital technologies to reimagine business processes and customer experiences, while others stated that it means delivering healthcare when, where and how consumers want it; or using data, analytics and artificial intelligence (AI) to improve outcomes.

According to the researchers, today, health systems fall into four key models of digital adoption: reliance on electronic health record (EHR) systems to drive digital engagement (Model 1); digital strategy singularly focused on virtualization of care (Model 2); stand-alone digital initiatives are driven by internal demand (Model 3); and strategic investments in long-term digital health platforms (Model 4).

Most health systems, especially smaller and mid-tier ones, operate in Models 1 and 2 and only the nation’s largest health systems are operating in Model 4. The majority of CIOs in the focus group, however, acknowledge that all enterprises need to shift to Model 4, the findings revealed.

“In my discussions with health system CIOs, what emerged is that not only are most health systems in the early stages of adoption, but there is no clear consensus on what digital transformation looks like or how to achieve it,” said Paddy Padmanabhan, CEO, Damo Consulting. “Most health systems consider their EHR system as their digital strategy or are developing standalone solutions on an as-needed basis, without a long-term digital strategy in mind.”

Meanwhile, while the adoption of digital transformation is slow and a clearly defined strategy is unclear, most healthcare CIOs recognize the valuable role it can play. Key trends driving its adoption include increasing competition and reduced reimbursements, along with the focus on patient experience and improving access to care for patients.

 

A CIOs approach to Digital Health

Health system CIOs in the focus group who are developing patient engagement applications expressed that they are actively looking at monetizing the capabilities by offering them to peer systems that are yet to make the investments. According to one CIO, “I think any digital transformation strategy has to have an affordability component because reimbursement rates are going down and we have to work smarter.”

What’s more, the majority (36 percent) of the CIOs in the focus group indicated that their organizations do not have a digital function, and by default, the digital function sits with the CIO. According to one specific CIO, “We don’t really have that (digital) function here. But if our board was asked who it would fall under, I could see them all saying it would be part of the CIO’s role.”

According to Padmanabhan, “It also comes down to whether health systems can afford to have another senior executive in a CDO role, given the current state of digital maturity and the lack of interest in creating even more C-level roles. Our focus group of CIOs believes most health systems are not large enough for two separate roles. This is in sharp contrast to other sectors such as banking, that have had full-time CDO roles for a while.”

Further, 46 percent of responding CIOs say that their enterprise digital strategy is their EHR system, closely followed by those that build or buy point solutions based on need (45 percent). Less than 9 percent are implementing an enterprise platform in partnership with a major technology firm.

“Based on these figures, it becomes clear that there is no single vendor platform that meets all needs and today, health systems must build their own stacks,” added Padmanabhan.















Report: Most Health Systems Still Lack Long-Term Digital Strategy: The survey of CIOs and other executives examined digital health maturation and how patient care organizations are strategizing for the future

OCHIN Partnership to Improve EHR Use for Epic, NextGen Users

New tools will streamline EHR use and reduce the administrative burden for providers using Epic and NextGen EHR systems.


Oregon Community Health Information Network (OCHIN) will integrate electronic consultation services (eConsult) into its Epic and NextGen EHR systems in an effort to streamline EHR use for providers and enable single sign-on capabilities.

OCHIN will partner with eConsult platform providers RubiconMD and Safety Net Connect (SNC) to cut administrative burden by reducing the number of clicks per day for providers and cutting down on EHR use.

The eConsult platforms will also allow OCHIN users to have access to web-based care coordination solutions designed to improve health data exchange among clinicians. Primary care physicians can use the technology to send a secure message and asynchronously consult a clinical specialist about a patient’s condition.

Specialist responses generated through eConsult are generally returned within 48 hours. By enabling more efficient communication between primary care physicians and specialists, OCHIN providers can reduce patient wait times for referrals.

"The integration of these eConsult platforms is a natural addition to our technology portfolio,” said OCHIN CEO Abby Sears. "We're dedicated to finding innovative technologies that make a meaningful difference for patients and the providers who care for them.”

The Oregon-based nonprofit health information and innovation network includes more than 10,000 clinicians across the country. OCHIN is a learning organization that leverages innovation and collaboration to improve patient health outcomes and reduce healthcare organization costs.

"This partnership is something our respective clients have been asking for and we are all too happy to work with OCHIN to bring to life their vision for improved workflow," said RubiconMD CEO and co-founder Gil Addo.

"We have long believed that transforming health care delivery will require collaboration between best of breed services, and this partnership represents a commitment to that ethos,” he continued. “Safety net providers will now have the ability to seamlessly access a top network of specialists within minutes, improving care for their patients while reducing costs."

OCHIN has steadily been working to integrate new types of health data and health IT into its network in recent years. In 2017, the non-profit integrated standardized social determinants of health (SDH) data collection and presentation into its Epic EHR to improve patient and population health outcomes in community health centers.

Researchers worked with 27 different community health center stakeholders to develop ways to optimize SDH data collection, present the data in the Epic EHR, and integrate the information into physician workflows.

Additionally, researchers developed EHR-based tools designed to help community health centers identify and address SDH-related health concerns. The ultimate goal of the project was to create SDH-related physician workflows aligned with clinical referral processes.

Participants in the study also developed EHR tools for reviewing SDH needs, identifying referral options, ordering referrals, and tracking past referrals.

There is growing recognition that social determinants of health data are a central piece of the health and wellness puzzle for the U.S. healthcare system. But while many healthcare industry executives are aware of the impact of social determinants of health on populations, there is no clear direction about how to operationalize its use. Because of this, the eHealth Initiative Foundation and the LexisNexis® Risk Solutions healthcare business hosted the second in a series of roundtable meetings on data governance in healthcare. The roundtable focused on data governance from the perspective of Social Determinants of Health, convening senior executives from across the healthcare spectrum. The goal of the meeting was to gather expert opinions on the use of social determinants of health data to benefit patients and providers.

This discussion produced examples across a variety of health plans of how social determinants of health data were being used to improve health outcomes. The examples articulated by healthcare executives illustrated how social determinants of health data is used to identify the most vulnerable populations and give providers and health plans meaningful insights into the health of their patients. Some of these use cases include using social determinants of health data to provide fresh food “Farmacy”, launch a togetherness program that improves outcomes for seniors and personalized behavioral interventions to improve medication adherence.

Author:  Gary M. Levin M.D.

OCHIN Partnership to Improve EHR Use for Epic, NextGen Users: OCHIN will leverage new EHR-integrated tools to improve EHR use and care coordination for Epic and NextGen users part of its network.

1.19 billion confidential medical images available on the internet

 1.19 billion confidential medical images are now freely available on the internet, according to Greenbone’s research into the security of Picture Archiving and Communication Systems (PACS) servers used by health providers across the world to store images of X-rays as well as CT, MRI and other medical scans.

US: 786 million medical images identified. HIPAA has been in effect in the U.S. since the mid-1990s. Despite these serious issues remain most probably due to legacy systems and/or poor implementation of cybersecurity. Some of this may be due to financial limitations.

That’s a 60% increase from the finding between July and September 2019 and includes details of patient names, the reason for examination, date of birth, and ID cards in some cases.

Amongst the 786 million medical images identified in the US, which had the largest increase in new data sets discovered, Social Security Numbers were included on some of the images, as well as some sets which listed details pertaining to military personnel IDs from the Department of Defense.

Overall, 129 new easily accessible archiving systems and data from nine additional countries have been discovered. Also, the number of images freely available on the internet had increased most significantly in the US, India, South Africa, Brazil and Ecuador.

Missing controls

Proper controls, such as HIPAA in the US, were largely missing. In total, the number of data records which are accessible online without any level of protection has doubled, from 4.4 million to 9 million, and the number of images now accessible or easily downloadable via the internet is 370 million.

Conversely, 172 PACS servers, including all systems from 11 countries including the UK, Germany, Thailand and Venezuela, had in fact been taken completely offline and the patient data was no longer accessible via the internet.

Addressing the situation

Dirk Schrader, cyber resilience architect at Greenbone Networks said: “Whilst some countries have taken swift action to address the situation and have removed all accessible data from the internet, the problem of unprotected PACS systems across the globe only seems to be getting worse. In the US especially, sensitive patient information appears to be free-flowing and is a data privacy disaster waiting to happen.

“When we carried out this second review, we didn’t expect to see more data than before and certainly not to have continued access to the ones we had already identified. There certainly is some hope in the fact that a number of countries have managed to get their systems off the internet so quickly, but there is much more work to be done.”

Hospitals and providers should review their PAC systems as they may not be part of their current electronic health record and lie outside of the boundary of the electronic health record.






1.19 billion confidential medical images available on the internet - Help Net Security: