Posted by: adelvecchio
Cloud, cloud ehr, data exchange, HL7, Interoperability
Where providers once questioned the security of the cloud and its compliance with HIPAA standards, they’re now accepting the relief it provides by allowing vendors to handle the majority of the security infrastructure for data and applications. In 2011, around 41 % of healthcare providers were using cloud computing in their practice or facility, according to the Centers for Disease Control and Prevention. Only a year later, MarketsandMarkets predicted that cloud computing would grow at a 20% rate in healthcare until 2017.
As a result of subsiding security concerns, cloud adoption has risen among electronic health record vendors as well. Vendors who offer providers an EHR platform deployed exclusively in the cloud have realized significant growth, as evidenced by Practice Fusion’s, Inc.’s rise to the top five in market share, and athenahealth Inc. penetrating the top 10.
As cloud-based EHRs become more prominent, it behooves providers to consider whether the cloud’s improved accessibility will ease interoperability between different EHR systems. Since many providers are attesting to stage 2 of the meaningful use program, interoperability should be top of mind. In order to qualify for these federal incentives, providers have to be able to share clinical data across “geographical, organizational, or vendor boundaries.”
The vendor boundary poses the greatest challenge. Many first-generation EHRs were deployed in a client/server model, which basically works in a closed network, where a server located in a physician’s office fulfills client requests on one network. Additionally, many of these on-premise EHRs store clinical information in disparate formats, making it difficult to transport data, though not impossible.
The disparate data formats employed by these systems has made it difficult to implement a standard for data transportation. The CMS admits that stage 2 interoperability includes data in many formats and exchange standards. Data standards are fundamental to interoperability, because providers exchanging data must have an understanding about the way clinical information will be structured in order to make sending and receiving an intuitive process.
Semantic differences and proprietary data storage have led to the rise of Health Level 7 (HL7), a text-based standard that client/server systems can use to communicate. It has been around since 1987 and works well with the majority of modern information infrastructure. However, clinical data must be converted into HL7, which still needs to happen at the organizational level, undermining the simplicity of the exchange.
It shouldn’t come as a surprise that the sharing of clinical summaries, i.e., text-based data, is more common among providers than the sharing of lab results. Even at the vendor level, HL7 adoption is not ubiquitous, which affects the transfer of data and software architecture.
Until recently, the EHR market was inundated with client/server systems; will the uptick in cloud-based adoption have a positive effect on interoperability?
Ostensibly, the answer should be yes. Cloud computing came to the fore in the business world as a method to store, share, and access data — making data democratization simpler than previous client/server deployments. However, cloud-based EHRs are still subject to the same data standards as on-premise systems. Sure, access and permissions can be granted more easily, but cloud-based systems would still use HL7 and other standards to exchange data, just like client/server models.
In fact, interoperability among different cloud computing applications remains a viable concern in industries outside of healthcare, albeit in a different manner. Outside of healthcare, businesses are more worried about vendor lock-in, or not being able to transfer their data from one cloud provider to another should they choose to switch. In healthcare, data transfer holds a greater implication: improving the quality of care delivered to patients through improved coordination among providers.
Certain cloud-based applications such as patient portals can provide patients with greater access to their healthcare records, though patient portals still necessitate oversight on the part of the patient. Effective interoperability would entail the automatic transfer of necessary information to the doctor a patient is referred to.
While interoperability can be achieved, it’s still mostly occurring on same-vendor systems. Certain cloud EHRs have made great strides in improving interoperability, but that is more often the result of focused collaboration between two entities rather than widespread acceptance of particular standards.
Other industries such as telecommunications, cable, and banking agreed upon a standard method for exchanging data because they saw a competitive benefit to doing so. Meaningful use stage 2 requirements attempt to create a competitive benefit by requiring clients of EHR vendors to share data across systems. Cloud-based EHRs may have an advantage because their systems are theoretically constructed with interoperability in mind, though they are still subject to the obstacles of exchange standards.
As it stands now, interoperability is slowly becoming more common. A cloud-based system alone is not enough to facilitate intuitive data transfer, though cloud vendors may be more capable of helping providers construct a plan for reaching that goal.
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