I’ve been baffled by the initiative to have doctors “connect” with each other and the plethora of electronic medical records (EMR) software on the market. In no way can one imagine that information sharing is wholeheartedly embraced, rather it is grudgingly so.
In a business sense, there is absolutely no business rationale to write software that cooperates with a competitor. Governmental regulations can “force” or “compel” interoperability, but if done with resentment, there will never be true information sharing.
Thus we come to the current enigma of “meaningful use” where software products must demonstrate information sharing in some form. If software had been built from the ground up to fight information sharing, how can it double back to do so. It cannot! In essence it is an added or bolt-on feature that suffers from a lack of foresight that such a need was envisioned or required.
It’s possible to demonstrate “meaningful use” to the satisfaction of some defacto regulation, but deeper information sharing that could meet a future social need might not be possible. The solution, therefore, is to program the EMR software from the concept stage to share information in some fashion.
When you think of what CIOs in big hospitals or individual doctors contemplating a purchase, there is absolutely gratuitous for a vendor to guarantee that their platform can be faithfully adapted to information sharing when its heritage had begun with an eye to proprietary and closed systems.
This brings the next dilemma. With 300 major software products on the market, how should health information exchanges in each of the fifty states choose for their member entities. It is unrealistic to believe that all 300 should be available but certainly a subset of maybe 10 or 20. It only makes sense that economies of scale can only be achieved if there is some standardization on a few vendors rather than all.
In summary, software may be dressed up with new technology. They may even act like they can share information. But can it really? Can a particular EMR software product born during the proprietary age of software transform or transition to an edge of information sharing? If it can, what kind of additional program modification is necessary to achieve it? The next time you sit down to sign that sales contract, hesitate for a moment and see what you will wrought on your organization.
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Interesting post, Dr. Hom.
Perhaps a particular strength of the web-based solutions is that there is less of a “transition” to make given their more recent development. And any transitions that need to be made can be pushed to all users at once vs. waiting for those enhancements in the server upgrade queue.
The penultimate paragraph confused me a bit, though. I guess I am of the understanding that meeting certification means these vendors’ products are capable of not only meeting clinical data measures, but also exporting data in an structured format that could be stored and easily accessible by any other certified program. Not sure if that is officially stated anywhere, but I guess it’s an internal understanding that I had. If that understanding is correct, then limiting choice of software shouldn’t be an issue. Said differently, if certification means the software is capable of “playing well with others”, does it really matter what solution an individual practice uses as long as the EHR is a certified?
Dr. BMP,
Thanks so much for your post.
I agree that it would appear to be anomalous that “meaningful use” certification should mean complete data integration but the unique nature of medical data means that the actual content is difficult to integrate.
To elaborate, we can say that two pieces of data may describe a retina in diabetes differently from one another. That lack of standardization is what confuses data integrators. Therefore, the ability to transmit the structure of data is rather easy (called the meta data), but the content is not easily understood once transferred.
Your final question of “does it matter” is partly true. However, meaningful use does not disguise the complexities of transferring from one product to another. So it does matter which one you select. It’s the one that will have the best chances of survival.
Thanks again for your thoughtful comments.
That makes sense. Thank you.
I didn’t consider how various programs might display data differently. I guess I was thinking that, for example, all eye-based EMRs would populate their retinal evaluations as text-fields. All other software (ie. other eye-centric EMRs, primary care EMR’s, etc.) could then “expect” retinal summaries to appear as text and be programmed accordingly. Perhaps I assumed that part of this certification process that vendors are undergoing was sort of a “language competency test” ensuring that the data output was going to be structured in a way to be compatible with all certified products. Is that not the case? If the certification process was just to prove that your software could produce the required data, but did nothing to establish some sort of “data format standard”, that seems terribly shortsighted.
Probably much easier said than done, but I’d still think that should be part of certification.
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