Interoperability: An EHR Litmus Test

By Don Jarrell

Interoperability has become a watch word in the healthcare business. The need to deploy electronic health record (EHR) systems across the board has put a strong spotlight on the need for different digital healthcare systems to communicate with one another, from doctor’s offices to hospitals to labs to insurers. Right now, they don’t. Perhaps more accurately, they don’t communicate fully and easily.

The interoperability problem is not a new one in the business world, nor is it confined only to the healthcare industry. The financial sector and the oil and gas industry have both succeeded in making complex data sets accessible across different vendors’ systems, so we know it can be done

Most if not all of the coverage given to this issue by the media is focused on the difficulties it presents to the provider-patient-insurer side of healthcare. While this is certainly part of the problem, there is more to the equation.  Many companies like ours provide solutions on the operational/quality/safety side of healthcare, and we continually see the effects that lack of EHR interoperability has on the patient quality and care staff with whom we work. Instead of improving operational processes, digital EHR systems create more work. For example:

• Needed data and information must be extracted “by hand” from the EHR and then re-entered, often with human “processing” in between.
• Data that could be useful as care quality indicators is not accessible from the EHR.
• Staff must fill data holes themselves, falling back on the (inefficient) use of spreadsheets and paper.

In short, what is experienced by too many users of EHR systems is akin to the closing scene of Raiders of the Lost Ark – vast storage with little chance of efficient retrieval for useful purpose.  Data warehouses are supposed to process all that data into easily-retrievable, value-added information products that serve the needs of users outside the system.

In an interoperable world, hospitals will use all the data available to them, no matter where the data resides, to manage and improve quality, and they will do so efficiently. All their digital systems will have access to discrete data elements and will be able to use this data easily. Equally important, there won’t be a demand for the labor-intensive tasks now required of staff.

For now, while we wait for full interoperability to arrive, the best you can do is be an informed consumer. Understand the interoperability issue, and be wary of sales peoples’ claims about the ability of their product to communicate agnostically.  Apply a litmus test to salespersons’ claims by making these key requests:

• Show me how a clinical manager can retrieve clinical care counts like the total number of Patient Days, Foley days, ventilator days, or medication doses administered.
• Show me how a quality manager can retrieve summarized operational and financial data used in quality and clinical performance management, like Cost per Patient Day, Length of Stay variables, and Admission, Discharge and Transfer (ADT) tallies.
• Explain to me how much of the difference between the demonstration and my “day 1” experience with the application comes from customization that takes time and that we must pay for.

At best, lack of interoperability is frustrating. At worst, it can put a hospital at risk. There is a lot of data locked in an EHR system, and much of it could make a significant difference to patient care quality and safety. Applying this litmus test to any EHR system you are evaluating will help identify the system that will best interface with the rest of your digital systems with the data that you need to operate efficiently.

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