Interoperability between different electronic health record (EHR) systems is one of the most important requirements that hospitals and physicians must meet as they prepare their systems for attestation in Meaningful Use Stage 2.
However, let’s examine the real goals of interoperability within healthcare:
1) To make sure “information follows the patient regardless of geographic, organizational, or vendor boundaries”
2) To have at least one or more instances in which providers exchange an electronic summary of care with all the clinical data elements between different EHRs. Establishing this connectivity does not insure the real goal of collaborating across the continuum of care for the patient’s benefit.
The debate still rages on the role of the patient in this interoperability process as well. We have all, as patients, had our medical files spread across a family doctor, multiple hospitals, specialists, health plans and today, even multiple pharmacies. The prospect of creating a complete picture is staggering, let alone having all of those healthcare providers really collaborate on our behalf. Is it the patient’s responsibility in this ever-changing healthcare electronic revolution to compile this electronic mess into a coordinated whole or will the industry magically create it as a result of Meaningful Use Stage 2?
It is worth arguing that interoperability in Meaningful Use Stage 2 only creates a baseline of connectivity between two or more systems to exchange information and puts in place the ability of those systems to use the information that has been exchanged. It does not create collaboration on behalf of patients within the healthcare provider community, especially between competing players like local hospital systems or healthcare providers versus payers. Having the ability to connect only trades fax machines for electronic transactions, if tools aren’t employed for physicians for example to collaborate over a single patient.
In advocating for collaboration, let’s examine the reality of an exchange of a set of electronic transactions about a patient versus where the process would need to be for genuine care coordination. Today, a fax from the hospital to the family physician is the notification that the patient was hospitalized and needs follow-up in coming weeks. Based on the type of hospitalization, a call between the attending physician and family physician may be warranted, and a potential referral to a subsequent specialist may be in order. Simply communicating electronic documents doesn’t address the interaction between key people in the decision-making process and the assumption that the inclusion of unstructured physician notes will suffice may be optimistic.
This means that health information exchange is different than health information interoperability. Exchange is necessary for interoperability, but it is not sufficient by itself to achieve health information interoperability, especially to streamline real collaboration on behalf of patients. It is time to examine an expanded view of both interoperability and health information exchange to promote ease of collaboration between the parties involved, including secure physician to physician communications – electronic or instant message, for example, and secure physician to patient communications. As an individual patient having to deal with multiple patient portals today for communicating with my healthcare providers, there is a real concern to address this issue sooner rather than clean up confusion later.
Can we define collaboration in a way that traverses healthcare’s landscape of emerging connectivity?