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Health IT Infrastructure Obstacles Stall EHR Interoperability

Health IT infrastructure upgrades and interoperability issues plague successful data exchange as organizations look for decentralized EHRs.

EHR interoperability

Source: Thinkstock

By Elizabeth O'Dowd

- Organizations still struggle with health IT infrastructure interoperability challenges as the entities digitize EHRs and other tools to improve workflow and patient care.

Entities are trying to determine the best way to adopt and deploy EHRs as they continue to develop their health IT infrastructures, according to a recent Black Book report.

"The global healthcare sector is undergoing a wave of transformation, with digitization being the core focus area of service providers," Black Book Research Managing Partner Doug Brown said in a statement. "Healthcare IT products, services and systems are in high demand in nations significantly upgrading their healthcare infrastructures.”

The report found that many organizations are looking to shift from siloed EHR systems. Containing EHRs in siloes can prevent EHRs from being compatible with other ones because of the isolation.

Interoperability challenges most healthcare organizations when it comes to EHRs and other health IT infrastructure tools that support EHRs. Entities are faced with legacy systems that do not communicate or exchange data correctly with more advanced systems.

EHRs are a significant interoperability challenge for healthcare organizations. Many entities are looking to improve or replace their EHRs to facilitate better interoperability internally and externally.

Interoperability issues begin with EHRs and extend to health IT infrastructure systems as more organizations digitize their infrastructure. 

Application Programming Interfaces (APIs) also play a large part in interoperability among disparate health IT systems.

An API is an interface that allows unrelated software programs to communicate with one another. APIs act as bridges between two applications, allowing data to flow regardless of how each application was originally designed.  

For applications that function by pulling a constant stream of data from one or more sources, an API is especially important to decrease development time and save storage space on endpoint devices. An API can also overcome any differences in the standards or programming languages used to create the data that lives at either end of the bridge.  

APIs play a large part in EHR interoperability and in interoperability between other healthcare applications. Cloud-based and on-premises healthcare applications need APIs to communicate standard information to each other to save time for both developers and clinicians entering information.

The patient-centric model many organizations are embracing also requires a high level of interoperability among different EHR systems. Patients are beginning to interact more with their own records and may need to present that record to multiple providers as needed for primary, emergency, and specialist care.

Lack of an EHR interoperability standard hinders successful data exchange. The current state of EHR design is a major problem for health data exchange, according to Nebraska Medicine Vice President of IT Brian Lancaster.

If a project requires two different systems to talk to each other, they're may not interoperable,” Lancaster explained to HITinfrastructure.com in a previous interview. “Eventually having a standard isn’t the issue. The issue is the lack of control organizations have over what goes into the transport mechanism.”

“I can create an EHR that has a patient’s problems, allergies, medications, and immunizations. If it's in the right ontology, other systems can read it,” he continued. “The problem is, each of these systems have so many configurations. You can’t capture a free text problem so that a note system can understand what it is without investing natural image processing.”

Clinicians don’t want to have to ask patients questions they have already answered because they were unable to obtain the answers from a different EHR.

Patients also don’t want to continue to answer the same questions, and often expect their record to easily be transported if they see a new doctor or go to visit a specialist.

The addition of analytics data from wearables and other connected medical devices also needs to be in a standard format so it can be exchanged and used for analytics.

Focusing on interoperability for EHR implementation can help organizations solve some of their current interoperability issues. Upgrading or changing to EHRs that cater to interoperability will help ease data exchange as organizations continue collecting more patient data.

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