Medical technology concept.
What are some of the challenges of making electronic health records more integrated? originally appeared on Quora: the place to gain and share knowledge, empowering people to learn from others and better understand the world.
Answer by Caesar Djavaherian, Co-founder of Carbon Health, on Quora:
There are many challenges in making electronic health records more integrated, including endless customization, vendor market share protection, health system market share protection, and technological factors. These are just some of the challenges of making EHRs more integrated. I’ll focus on the customization issue.
Currently, if you are a health system running an instance of the leading enterprise EHR systems and across the street is a different health system using the same EHR vendor as you, the two systems would not directly communicate with each other because they have been customized to such an extent that the data elements would not directly match up. So a patient who is seen at their doctor’s office running Cerner, Epic or Allscripts may show up at a competing hospital’s emergency department who has the same software, but their discrete granular data from their doctor’s office would not appear in the other hospital’s records. The best we have done with interoperability is getting one system to send a pdf version of the patient data to the other system to view, which is essentially a modern version of the fax machine.
A question that commonly arises from the patient perspective is, “Why did it take an act of congress to force electronic health record vendors to integrate their technology with each other?” Like most technology products, the more information that flows from one to the other, the more both sides would have access to better data about their users. We see that happen when websites allow you to login with Amazon or Google. But in the healthcare world, where data sharing amongst providers is arguably the most important realm, the established EHR vendors decided to set their own information exchange platforms rather than coming up with an industry standard for sharing granular data. The backdrop is that the legacy EHR vendors have been in a battle for market share and keeping their customers hostage in their ecosystem means that they cannot switch away from their software without significant barriers and concerns about lost data. Under the Affordable Care Act, vendors were forced to open their data to exchanges and common communication languages such as FHIR. This bold step has created an incredible opportunity for innovation to come to healthcare data that can be shared rather than siloed.
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