Could EMR software make healthcare worse?

This post is based off of an interview posted on the IBM Impact Blog. Visit us in the Industry Zone at IZ-4 or check out our IBM Impact landing page

Widespread electronic medical record (EMR) adoption is hanging on hope that social and economic benefits will be received through the reduction of information silos in medical record data. Unfortunately, without interoperability EMR adoption will only further strengthen the information silos that exist in today’s paper-based medical files. This will result in even greater proprietary control over health information and, with it, control over patients themselves, which will greatly limit the innovative promise of future healthcare systems. Public efforts to support adoption of EMRs that are not interoperable are questionable, since stand-alone EMRs might not increase the healthcare consumer’s welfare. In contrast, EMR adoption enhanced by interoperable information will increase consumers’ welfare through increased choice, portability, and control.

Let’s not think about interoperability only in today’s terms. Innovations in telehealth will place enormous demand on health information exchange and the benefits delivered from interoperability will be without question. Streaming real-time video interactions among physicians and between physicians and patients will be integrated into the EMR in some form and will require profound broadband capacity. Monitoring of live-feed data from the homes of the elderly or ill patient will tell clinicians and family members about medication use, mobility, food consumption, and other aspects of daily living. Wearable or implantable medical devices with wireless feeds will report patients’ physiological status to physicians. And that is not to mention inputs about weight and reaction times from automobiles, ambient environmental sampling data linked to one’s location by wearable global positioning system (GPS) devices or smart phones, exercise data from wearable heart monitors, insulin pumps, and sensors at one’s desk for other kinds of metrics. All of these data collection devices need to be tied together with bidirectional standardized messages.

The Future of Interoperability in Healthcare

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The future of interoperability is to bind together a wide network of real-time, life-critical data that not only transform healthcare but become the new way of providing healthcare. Despite the benefits of interoperability, they may be difficult to realize. The reason for this is three fold:

1. Interoperability benefits are highly dispersed across many stakeholders – doctors, patients, device manufacturers, and software developers to name a few. Some parties could lose from disruption of long-standing industry practices, particularly vendors who rely on custom integration of their products for revenue and who use the lack of interoperability as a customer retention strategy.
2. The cost of early adopters will penalize them and make it difficult for interoperability to establish momentum in broad geographies. Just like the fax machine, the last to install an interoperable EMR benefits from everyone else’s prior investment, and the first to install bears most of the cost.
3. Interoperability technology heat seekers have faced many barriers and challenges that have resulted in partial success, slow progress, and outright failure. Adopting standards for interoperability could mitigate these costs and barriers. Interoperability may be beneficial and reduce costs, but it is certainly not easy.

Interoperability Must Precede EMR Adoption

The key question about interoperability is how it should proceed relative to EMR adoption. My point of view is typically that interoperability has to precede EMR use. It is based on the belief that the ability to share information has to be designed into EMRs and that the infrastructure and industry capacity for securely networking this information has to exist up front. There is a very real risk that the widespread adoption of stand-alone EMRs without interoperability is simply a lost opportunity and one that may lead irreversibly to treatment of health information as a proprietary asset of delivery systems. If interoperability standards are not solidified and built into EMRs now, many large healthcare investments in EMR software will be wasted.

There are IT professionals that will argue that interoperability will follow after widespread EMR adoption. These individuals believe that once health information is electronic and everyone is using EMRs, interoperability will naturally follow, since it is easier and cheaper than manual data sharing. They view up-front requirements for interoperability as too restrictive and think that standards will naturally evolve from the point-of-care information infrastructure that the United States healthcare system is building.

Key Benefits from Interoperability Implementation

This “chicken and egg” debate needs to take place immediately while incentive dollars are being spent to get EMRs implemented especially in medium to large healthcare organizations. There needs to be clear thinking on when interoperability standards are brought to adoption during the EMR implementation. Let’s not underestimate the true benefits of interoperability for EMR adoption. Here are three key benefits to be realized by interoperability and the first one is a key consideration for organizations starting or in the middle of EMR implementations:

1. It makes your Electronic Medical Record (EMR) software easier to implement. One of the challenges of implementing large-scale EMR software (Cerner, EPIC) is that the healthcare organization has to continue to operate during the implementation. An interoperability solution can take information from your existing systems that produce HL7 or ANSI X12 transactions, laboratory systems, ancillary systems or newer medical devices and feed that data to the new application. As a result, the data entry or data collection process to start-up or parallel test the new EMR system can be reduced and, in some cases, eliminated. The cost and time savings will more than justify the cost of the interoperability solution.
2. It can collect near real-time transaction information for improved operations. Simply saving the HL7 transactions being created and transmitted between your applications can provide valuable insights into daily operations. The near real-time capture of HL7 transactions will allow the creation of event notification systems to react to operational needs, patient safety or quality initiatives.
3. An interoperability solution will integrate current healthcare applications and future software acquisitions. Most modern healthcare applications speak HL7 standard messages or they can be interfaced to create HL7 or ANSI X12 messages. This “common language” allows healthcare organizations to integrate the disparate applications in their IT environment including registration systems, lab systems, core measure tracking, surgical software suites, and newer medical devices. In addition, the common language of electronic transactions allows integration with external organizations – vendors, other healthcare organizations, providers and national level organizations.

If interoperability can gain center stage, clinicians could have the information they need at the point of care, consumers (patients) would have choice and portability, payers would save money, and researchers would have better data. Many healthcare organizations already own the toolsets or could pay for the software toolsets for interoperability from savings in productivity and reduced errors. Let’s grab the golden ring of interoperability while we are on the merry-go-round of going electronic.