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Where EHR interoperability, open systems and data governance meet

Open EHR systems can be more interoperable, but data governance can suffer. Developers must strike a balance between open and closed.

Does interoperability or open systems drive innovation when it comes to EHR systems?

When it comes to software solutions and interoperability, many industries can sometimes be ahead of healthcare. Whether it is in the level of integration capability or level of system openness, other industries have been using enterprise project management (EPM) systems for many years and have been able to see a significant number of innovations and powerful global integrations with them.

The same level of functionality has to come to healthcare. There are certainly health organizations with very expensive electronic health record (EHR) interoperability packages that offer a significant number of other benefits, including functionality and integration. While they still are considered closed systems, these EHRs have the ability to exchange data. EHR data governance standards can be easier to manage in closed systems.

However, we are still seeing access and information exchange challenges with these systems with most patients when they visit their primary care physician. Cost does play a factor when it comes to interoperability and the ability to build features that offer ease of integration with other systems. This highly competitive landscape for EHR vendors forces some providers to rethink their interoperability plans.

One area hurting some healthcare software vendors more than others is the platform chosen to store data. Innovators and software developers are unenthusiastic about creating applications for closed EHR systems, as these systems might use unpopular database engines and make it too difficult to interact with data housed inside them. But this lack of enthusiasm simply increases the obstacles and hinders access to building automations that can solve workflow, point-of-care and other end-user challenges.

That said, as we review the types of systems that may offer strong EHR interoperability versus ones that are open to capabilities for integration via application programming interface or Web services, we clearly discover that one type doesn't distinguish itself from the others; they all have tradeoffs.

Interoperable systems enable the exchange of information in a standardized format. The data can either be clinical or administrative, and applications with this type of support tend to easily connect with most systems such as health information exchanges (HIEs), various EHRs and other tools that exchange data. By having this functionality, EHR systems can control the information that is exchanged and tightly maintain standards and rules.

Open system can mean a lot of things, depending on who you talk to. Some EHR vendors might define an open system as one where data is stored in a common marketplace database engine. However, it is usually not recommended to access the data directly without specific guidelines from the vendor. There is also the EHR system that offers capabilities that enable the access of information via Web services and other means and can enable third party vendors and developers to interact with the data while still staying in compliance with the vendors.

A balanced approach, from a software design and architecture standpoint, is the best option. Some openness, good controls and strong interoperability are what should be prescribed. Innovation is the result of a need and an opportunity to fulfill the need by resolving it via some integration, and automation. And as long as there are EHR vendors that recognize the value and need for that, then systems will continue to have more openness and integration capability.

About the author:
Reda Chouffani is vice president of development with Biz Technology Solutions Inc., which provides software design, development and deployment services for the healthcare industry. Let us know what you think about the story; email or contact @SearchHealthIT on Twitter.

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