How Interoperability Stitches Together EHRs

A recent study from the Office of the Inspector General discovered that accountable care organizations (ACOs) that use a single, shared electronic health record (EHR) are better at coordinating patient care.
While it’s nice to have a government study validate one of my long-held beliefs, there’s an element of frustration, too. “Really? We’re just now realizing this?” This evidence is helpful, but we need to acknowledge the elephant in the room: interoperability.

Why Interoperability Matters

Interoperability is, in essence, a solution that allows different systems to communicate seamlessly without information loss or large gaps in time.
Furthermore, interoperability is not merely data sharing. Rather, true interoperability requires aligning workflows. When workflows aren’t synced, doctors — who, for all their genius, are not IT specialists or certified medical coders — have to patch together workarounds. This “MacGyver” approach costs money, leaves patient gaps unfilled, and perpetuates the siloing of information.
For example, providers on the same EHR can have a secure dialogue about a referral and consultation. If they’re not on the same EHR, the conversation is a poorly documented, possibly unsecured order faxed back and forth with notes penciled in haphazardly based on phone calls. Their conversation is not only painstaking for the providers, but potentially dangerous to the patient.
When systems aren’t interoperable, providers are forced to communicate at the lowest common denominator. Aligning data exchanges and workflows is what enables ACOs on a shared EHR to thrive. There is a way forward though, and that way involves implementing unified patient chart within a single-instance healthcare delivery platform.

Envisioning a New System with Single-Instance Platforms

A single-chart or single-instance platform would bridge “healthcare islands.” To illustrate this, let’s look at referrals.
The referral process can be disjointed. We all know that. But a single-instance delivery platform would streamline this burdensome process from beginning to end. For instance, an internal medicine provider refers a patient to see a cardiologist and endocrinologist. The complexity and stakes require providers to have a dialogue to coordinate and align actual care, not just care-plan documents. The providers could use the EHR to book a patient’s appointment, ensuring continuity of care and timeliness. This prevents the patient from forgetting or delaying treatment. Finally, the single-instance chart would include the referrer’s as well as the consulting doctors’ notes and any consequent follow-up care. This measure avoids inefficient methods, like faxing patient records, while enhancing provider collaboration and communication.
Viewed broadly, this system reduces duplication by making everything visible in a smart, streamlined manner. It fosters communication; When providers share a single chart, they see the same data and speak the same language. This cuts down on waste and can improve the health of patients. The single record stays relevant for years and cuts down on accidental duplication of tests and other problems in the continuum of care.
The same system probably aligns providers to operate as a virtual care team, supported by a secure messaging system that allows a dialogue about shared patients. When care teams’ clinical conversations are consolidated into a shared view, providers can make faster, better decisions about patients’ health without stumbling through “interoperability” hurdles.

What Barriers Stand in the Way?

This system may sound simple, but it won’t be easy. It’s a paradigm shift, a term I don’t use lightly. The study I talked about at the beginning acknowledged the large price tag of the overhead costs, the re-training, and data transfer. Additionally, it’s aggravating to change EHRs. Workflows change and productivity may slow during the transition. Providers — understandably — get upset with the new system while they’re adjusting.
However, I’d argue there’s also a major cultural shift that can be discomforting. The model of each practice, or even every provider, tinkering with their EHR and customizing it to fit their exact specifications is replaced by uniformity. While customization is great for some things, this shared EHR reflects a progressive commitment to the “bigger picture” of healthcare.