EHRs can’t exchange patient records? $$ in workarounds.

Some of the Excedrin/Panadol Headaches (#11, #14, #23 and #54) in healthcare are around the very ‘miracle technology’ that was supposed to make it all seamless, non-duplicative, time/cost-effective and coast-to-coast–EHRs. The exchange of patient records between hospitals, within health systems between sites and with medical practices plus vice versa–works haltingly if at all. It works best within well-established, highly integrated delivery systems –the VA, DOD, Mayo Clinic, Kaiser, Geisinger, Intermountain Healthcare. But once you’re away from it–good luck. Where are the problems? The closed standards of the major hospital EHRs–Epic, Cerner, Allscripts, McKesson and brethren; the extreme customization most health systems demand (nay, a major Epic selling point!); structured versus unstructured data and how handled; a lack of a secure interoperability standard are but a few. Where is the gold? Getting patient health records exchanged, accessible and transportable, among systems that were essentially designed not to speak with each other.

  • New York State, as many others, have developed regional exchanges called RHIOs (regional health information organizations, now Qualified Entities) to promote the exchange of electronic health records. This year, the statewide network of the nine QEs, the Statewide Health Information Network of New York (SHIN-NY, “Shiny”), with 50,000 healthcare providers and over 7 million consenting residents, will be fully interconnected as the first large health information exchange in the US. Cost: $45 million this year. NY eHealth Collaborative (NYeC) has been active in coordinating support for this as part of innovation in the tech sector. SHIN-NY support letter to the state legislature.
  • The bad ER/ED experience of a Silicon Valley techie and the search for his tetanus shot records inspired him to start Syapse to create a database out of the unstructured data in medical and genetic information. The Argonaut Project wants to make exchanging health data easier between app developers and EHRs using open standards and public APIs (application programming interfaces). Also proposed again is a system using a national patient identifier number, but that has raised major security problems similar to SSIs. KQED Science (hat tip to Angela Speziale of Call A Doctor Plus Telemedicine)
  • The national OpenNotes Collaborative, started in 2010, also seeks to open up clinician notes directly to patients so they can read them and discuss with their doctor. 4.8 million patients now have access to their notes through major healthcare organizations.
  • On the highly technical side, HIT types are looking to HL7’s web-based Fast Healthcare Interoperability Resources (FHIR, “Fire”); at the recent HealthIMPACT East, HL7’s Charles Jaffe stated that most of the major EHRs are putting it into place.
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