Current Challenge of EMRs: Interoperability


 
When the mandate for electronic medical records was proposed years ago, the concept was this: with appropriate digital infrastructure and sophisticated IS support, each patient's entire medical record could be available for review by any physician involved in care wherever the patient presented, whether in a physician's office or in a hospital. With quick access to full clinical information regarding the patient right at the point-of-care, physician evaluation could proceed in an information-rich environment, minimizing redundant testing and reducing errors in clinical decisions.

Having the ability to review any and all procedure reports and lab results  -  and also to read the clinical notes of a patient's other physicians (which contain their clinical assessments and plans of care)  -  improves the quality of a physician's clinical decisions, which are being made in real-time at the point-of-service.

Health Information Exchanges (HIEs) have been proposed as shared repositories in which each patient's clinical information could be stored securely and then accessed only by physicians involved in care, whenever that patient is seen in a physician office or admitted to a hospital. HIEs remain only a concept, however, and have not yet arrived, even though - by mandate - most physician offices and hospitals have already adopted electronic medical records (EMRs) and have digitized clinical records. 

The current challenge in today’s EMR environment is providing interoperability between the separate EMRs that contain a patient’s clinical records. That way, when a patient is admitted to a hospital, records from the physician office EMR can be accessed and reviewed by the physician at the patient's bedside and used to create an informative H&P or consult note document. When a patient returns to the physician office for follow-up, not only the hospital discharge summary, but also any diagnostic test reports, lab results, consult notes, and procedure notes can be accessed and reviewed by the patient’s physician.

Using existing digital infrastructure and setting compatibility standards for documentation (using HTML text files instead of scanned or faxed image files, for instance) is critical in this two-way communication process. While use of faxed image files gives a semblance of a bona fide EMR, it creates a bulky collection of image pages, which must be viewed one-at-a-time and cannot be accessed by the physician end-user to select portions for inclusion in a live H&P, consult note, or progress note. This is simply a facsimile of what an EMR is designed to be.

Maintaining the necessary interfaces, which automate or facilitate transfer of specific digital documents between the separate EMRs, requires cooperation between responsive and sophisticated IS support teams (in hospital and physician office). 

Honest appraisal of the functionality of the composite physician end-user interface (office EMR + hospital EMR) is needed to provide an improved physician experience. Both the physician and the patient receiving care benefit when EMR interoperability is delivered and maintained.

 


James Boogaerts, MD, FACC practices cardiology with Cardiovascular Associates.

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