Three Challenges Standing in the Way of Interoperability
By 2024, the U.S. Department of Health and Human Services is striving for interoperability between all electronic health records systems (EHRs). This would mean that patient data could be passed and shared between authorized practitioners more quickly and more fluidly. For the patient, sharing records electronically seems logical and efficient, but as of today, there are many challenges standing in the way of complete interoperability. Below I’ll outline three major complications:
The systems and software variations are too vast:
Oftentimes, when a patient switches practices, they have to bring their records in manually, in paper form if they have access to the records at all. It seems incredible that in 2016 we’re relying on paper records. Until systems work in tandem, however, there is no other choice. Different EHR products have different functionality, application, and purpose, making them difficult to standardize. It would be great if there were a single format used for sharing data, but that is simply not the case.
Interoperability extends beyond sharing records, into the realm of medical devices, services, and clinical operations. The sheer amount of services provided make it even more complicated. Unlike mobile-based applications that are able to work on multiple operating systems, the healthcare industry has not adopted the same attitudes toward application programming interfaces (APIs). Many health records are closed and do not publish APIs, limiting the capabilities of software developers to access information.
High Data Exchange Fees and Data Blockage:
While it is difficult to share information across multiple systems, it is in many cases possible. The catch? It can cost a lot of money to set up these types of transfers. As noted by a 2015 Politico article, “doctors pay $5,000 to $50,000 each for the privilege of setting up connections allowing them to transmit information regularly to blood and pathology laboratories, health information exchanges, or governments, according to more than a dozen sources.” This seems rather extreme, but the federal government and many state governments have taken notice. In the beginning of April 2016, the Department of Health and Human Services proposed a rule, which would allow them to have direct review of EHRs and a greater oversight regarding health IT. Until the government steps in, there may be little incentive for companies to stop data blocking.
Lack of Usability and Frustration:
Beyond the obvious difficulty of coordinating hundreds of programs across hundreds of platforms, is the inconvenience physicians face when actually integrating EHRs into their everyday habits. Whether it’s inputting patient information, figuring out how it works, or trying to share the information, EHRs can disrupt the doctor-patient experience. These types of disruptions inevitably lead to frustration.
Many doctors feel that rather than streamlining their work, technology has actually created more of a barrier, in the form of a screen, between them and their patient. This is troublesome not only because it interrupts the patient’s visit, but can lead to visits lasting longer than intended, causing less patients to be seen. The strain leads to clinics lamenting over the technological shift rather than seeing the benefits, thus causing more disparity between multiple systems and disciplines.
EHRs are undoubtedly the future, but until there is more standardization, less data blockage, and increased intuitiveness for users, the clinical community will continue to be resistant to changes. The solution, or many solutions, has to come from the ground up rather than merely addressing problems as they appear.
Max Gottlieb is the content manager for Senior Planning. Senior Planning is a free service for seniors and their families—helping them apply for benefits, look for care, or transition into long-term care settings.
