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The right kind of interoperability must become reality


Solving the problem of electronic health record (EHR) interoperability is just a small step toward integrating the exploding healthcare information technology system.

Hospitals and physicians have made progress toward secure data-sharing. Patient portals allow limited communication with clinicians. Pharmacy drug-drug interactions and disease-focused case management are done electronically. But how do these interfaces address the proliferation of personal healthcare technology?

Almost a decade ago, Newt Gingrich declared in a speech to the AAFP Scientific Assembly that developing a unified platform for medical data would be a top government priority. So why hasn’t that happened? At that time, the “Internet of Things” was just beginning and the ability to store and access data remotely in the “cloud” did not exist. EHR development was focused on converting physician notes and labs into searchable archives.

Related:The debate over healthcare interoperability

Since then, advances in mobile technology have empowered patients to analyze and manage their own data. It is too late to retrofit all EHRs, but we still have the opportunity to shift the focus of healthcare IT development to include all the places that patients access care and generate health data. Instead of continuing to build on the complex EHR framework, new development should focus on cloud-based, HIPAA-secure data interchanges.

Patient portals are required for meaningful use, but each portal is customized for a healthcare entity. Three hospital systems in my area use the same EHR vendor, but access to each patient portal is slightly different. In addition to having to remember three separate logins, many of my patients navigate online access to their healthcare data at their health insurance provider, employer health website, veterans administration, specialty clinics-and none of this information directly integrates with my primary care clinic’s EHR.

Maybe it is time to let go of the vision of standard platform data interchange and start creatively designing a system that can organize the many places that store and collect patient healthcare data. How about a hypothetical “Personal Health Dashboard (PHD)” application which would be chosen and managed by the patient? The Cloud-based PHD might function like this: After a consult note arrives in a patient’s chart, my EHR would automatically generate a notification to the patient’s PHD. Similarly, imaging results from an urgent care clinic or sleep data generated by a mobile app would link to the PHD, which patients would view on the device of their choice. Patients would no longer be responsible for multiple portal logins and separate interfaces.

Related:ONC aims for improved interoperability by 2017

With these apps, patients could allow family and doctors to access amd exchange data with agencies of the patient’s choice. This would enable development of new tools for analyzing the data over multiple platforms because access would be controlled at the dashboard level, while HIPAA-covered entities and vendors would continue to manage the security of data storage, effectively solving interoperability.

Interoperability is an issue of safety and patient-centered care. It is no longer a question of whether EHR interoperability is going to happen. The question is, can we do it right?

Melissa Lucarelli, MD, is a full-time independent family physician who practices in rural Wisconsin. She is a member of the Medical Economics editorial board.


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