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Interoperability and the Electronic Health Record: The Journey Continues

A HIMSS17 presentation examined the progress and future of interoperability

February 19-23 marked HIMSS17 in Orlando, FL, with 40,000 healthcare IT professionals, clinicians, executives and vendors from around the world.

Kathleen Sheehan, Program Director of Meaningful Use at Universal Health Services, Inc., addressed “Overcoming Challenges/Obstacles to Achieving Interoperability.”

“While years of specialized committees and concentrated initiatives have made tremendous progress in enabling interoperability, the reality of a single Electronic Health Record (EHR) continues to elude the healthcare industry,” says Sheehan.

Sheehan’s presentation recapped the generation life cycle of interoperability and provided possible solutions for what’s next.

Generation 1: Secure Email

Prior to 2014, interoperability was limited to proprietary EHRs connected by HL7 interfaces. Patient data was only accessible via FAX, CDs or paper. With Stage 2 meaningful use, legislation introduced secure email as the first generation of interoperability.

Hospitals and providers were incented to participate, but the standard list of approved data fields proved lacking. Workarounds such as attaching files to secure messages became common and problematic.

As a mechanism for exchange in the ambulatory space, secure email was fairly easy to adopt within the context of existing workflows. However, this was not the case in the acute setting for health records at the point of care.

Patient Portals

While Generation 1 provided limited operability, 2015 saw the introduction of portals that enabled central access to a patient’s health information. The EHR incentive program’s objective required eligible hospitals and providers to offer portals to patients.

In theory, all data from specialists and provider portals would go back to the primary care physician portal, enabling a more complete EHR. In practice, an unintended consequence is what Sheehan terms portal confusion — a patient can end up with several accounts, resulting in their health-related data being stored in several locations.

Generation 2

Stage 3 moves the industry to a decentralized commodity-based model, the federated model. Many believe this will break down exchange barriers and enable meaningful exchange “on-demand at the point of care.” While vendor membership is voluntary, it’s critical for the industry to realize the benefits of interoperability — reduced cost, improved quality and care coordination.

Perpetual Health Record. The next generation?

Sheehan’s proposal to lift the EHR to the next level is what UHS calls the Perpetual Health Record. With a patient’s permission requested at the point of service, a patient’s health records located in EHRs and portals are transferred to a centralized health record. Care providers can query a single comprehensive repository of the patient’s perpetual health record. There are initiatives underway that include a voluntary exchange mechanism and care coordination efforts, but critical components will include required pieces of a patient’s record.

At HIMSS, Sheehan’s presentation generated thought-provoking conversation across the board. UHS’ Perpetual Health Record proposal is basic and visionary… making the next generation of an EHR the closest yet to reality.