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EHR interoperability, regulations top patient record concerns

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CIOs address EHR problems, focus on lack of interoperability

It's no secret that EHR problems are aplenty in healthcare. But the lack of interoperability is top of mind for many in health IT. Two healthcare CIOs share their stories.

While the billions spent in EHR technology have helped providers improve care in many ways, a common roadblock remains when organizations try unsuccessfully to share medical information through different electronic records systems.

Two hospitals recently shared their different approaches to solving these EHR problems and interoperability challenges. In both cases, each organization embraced a new way of thinking using technology.

Children's Hospital of Pittsburgh of UPMC chose to build its own software to combat interoperability problems, while Phoenix Children's Hospital is looking beyond its walls to solve the problem.

Healthcare CIOs believe in technology and its ability to transform healthcare. The proof is in the billions of dollars that have been spent on various health IT systems and technologies -- including EHRs.

EHR problems: The continued lack of interoperability

Our situation is a little unique because with UPMC we actually have two of ... the biggest [EHR] vendors in the country.
Harun RashidCIO of Children's Hospital of Pittsburgh of UPMC

While moving onto Allscripts' EHR may have helped Phoenix Children's in solving its EHR problem, another problem remains, David Higginson, executive vice president, chief administrative officer and CIO at Phoenix Children's Hospital, said. And that is concerning interfacing, communicating and sharing data with various accountable care organizations and physicians in the community.

That "is much more important to us because those providers are in the community ... taking care of patients as a continuum," Higginson said. "You have to be able to gather all that data from all those providers, and they're all on completely different EMRs."

Harun Rashid, vice president of Global Health Services and CIO at Children's Hospital of UPMC Harun Rashid

Harun Rashid, vice president of Global Health Services at the University of Pittsburgh Medical Center (UPMC) and CIO of Children's Hospital of Pittsburgh of UPMC, also faced an interoperability challenge. However, "our situation is a little unique because with UPMC we actually have two of ... the biggest [EHR] vendors in the country," Rashid said.

UPMC uses Epic's EHR for ambulatory and Cerner's EHR for inpatient, Rashid explained.

"That in itself creates a significant challenge because both vendors don't talk to each other," he said. "We found that the vendors were not very receptive to make that work so we had a solution we created in-house."

UPMC created this in-house approach in partnership with dbMotion, an Israeli software company that lets healthcare companies take data from two or more EHRs and normalize it so the two systems can talk to each other.

DbMotion: Tackling EHR problems by creating interoperability

"What our [interoperability] solution does is pulls together all of those different types of medical information into a central location, and then it links it to standard based nomenclature so that they can be compared," Jim Bresee, vice president of solutions management at Allscripts, said.

Bresee also explained that dbMotion's software keeps the original source content exactly as the first physicians recorded it at the point of care. "Then we link the concept that they documented to the standard-based concept," he said. This allows physicians making clinical decisions to map back to what another physician said. "You don't want to lose any of those very important kernels of knowledge the physician put in there."

Furthermore, dbMotion's interoperability software is able to query various database nodes throughout an organization or even a country.

"For example, in the country of Israel, we have 32 connected database nodes," Bresee said. "When we ask a question of the Israeli system, it will look to all 32 nodes before answering the question and will provide us a comprehensive view of that patient across all of the 32 nodes in the country."

Because of the success UPMC had with the in-house interoperability software, it was sold to Allscripts for $235 million in 2013.

"So when a primary care doctor in a remote community has an understanding that his or her patient was seen at a UPMC emergency room, and that information gets passed on to the primary care doctor, ... he or she is able to see, and then they can do follow up treatments," Rashid said.

What Epic and Cerner have to say

However, Epic's vice president of client success, Eric Helsher, believes the lack of interoperability doesn't lie with any one vendor or healthcare organization. Instead, it is an industry-wide problem that will take everyone -- providers, vendors and other healthcare organizations -- to solve, he explained in an interview with SearchHealthIT.

"I've seen organizations or providers, CIOs, they have to go above and beyond the current interoperability standards to do a more custom interface to share more information between those systems because the industry as a whole has not yet come together on a complete set of technical standards, as well as clinical terminology standards," Helsher said.

However, both Epic and Cerner claim that they do share data.

"Overall, Cerner has a strong track record when it comes to exchanging information with other systems," Cerner's Vice President of Interoperability, Bob Robke, said in an email. "There are nearly two dozen active projects where Cerner is connecting with Epic."

Possible alternative approaches: HIEs

But not every hospital or healthcare organization dealing with the lack of interoperability has the means to build their own software to create that interoperability between all the EHRs that are being used either in their organization or by other organizations they wish to share data with.

Higginson believes that another potential answer to EHR problems could be state HIEs -- although a federal-level HIE would be ideal, he said.

In Arizona, the state HIE is very active, and providers are encouraged to connect to it rather than each healthcare organization making individual connections to each other.

"If you can imagine, my hospital is trying to connect to 80 different providers," Higginson said. "Then other big hospitals in Phoenix are also trying to connect to those 80 providers, and you end up having this tangled web of connections rather than everybody going through the state HIE."

Higginson explained that the HIE would serve as the plumbing to move data around, and no matter what EHR a hospital may be using, if they are connected to the HIE, then data can be shared among organizations. "I think it's a possibility for an HIE going forward," he said.

Although CIOs and healthcare organizations may be finding their own answers to the lack of interoperability among EHRs, it seems that no matter the CIO, all seem to agree that when it comes to the lack of interoperability, "these are challenges and barriers that have to come down for us to be able to successfully enjoy the electronic health record," Rashid said.

Next Steps

Learn who the top EHR vendors in your state are.

The EHR market via meaningful use attestation stats

How to avoid EHR errors: A MGH physician weighs in

This was last published in May 2016

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