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EHR Interoperability

The transition from paper files and charts to electronic health records (EHRs) promised to transform healthcare, but without full EHR interoperability the full potential of EHRs cannot be achieved.

The main benefits of EHRs are to ensure all people who need access to patient information can view patient data when and where they need it. EHRs allow efficient exchange of healthcare data and allow healthcare organizations to improve efficiency and productivity. With a central repository for all patient information, clinicians can always act on up to date information, which reduces the potential for medical errors and improves patient safety. Even though implementing EHRs can cost many millions of dollars, a great deal of money can be saved through improvements in efficiency and productivity over time.

Unfortunately, while EHRs have been adopted by most healthcare organizations, the EHRs used by each are often different which makes data exchange problematic. While data is stored in electronic format, transferring that information between two different systems can be far from straightforward. Different EHRs store data in different ways and many use proprietary data formats. EHR interoperability is concerned with getting these different systems to exchange and cooperatively use data to optimize the health of individuals and populations. To achieve that goal, electronic information in one system must be securely exchanged with other systems without requiring special efforts or manual processes.

According to HIMSS, EHR interoperability occurs at three different levels. First, is foundational interoperability: Data must be exchanged between two different systems without the receiving system having to interpret the data it receives. Second is structural interoperability, which is more complex as the structure of data is defined and interpreted at the level of each individual data field, while ensuring data is preserved and unaltered. The final level is Semantic interoperability, which is where data is exchanged by multiple, disparate systems and used to its maximum extent. This stage involves healthIT systems all speaking the same language. That means health data does not need to be interpreted to be understood and made actionable.

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EHR Interoperability Standards

EHR standards are architectures that allow different EHR systems from different developers to communicate with each other and exchange data efficiently. The use of EHR interoperability standards helps to improve quality of care by making the right healthcare data available to the right people at the right time. Even though EHR interoperability standards have been developed, there is no single standard. True EHR interoperability has still not been achieved.

There are several standards for healthcare interoperability, the most widely recognized of which is FHIR (Fast Healthcare Interoperability Resources). There are other standards for different data types and processes which include DICOM for sharing medical images between different systems such as picture archiving and communication systems (PACS). There is ICD-10, which uses standard codes for diagnoses and procedures for billing, and HL7 V3 for the exchange of demographic, clinical, and administrative data. and many more. While these standards are important, until there is a single technical standard, full EHR interoperability will be difficult to achieve.

Unlocking the Potential of EHRs

EHRs have tremendous potential but they are fundamentally data repositories. They are not built for sharing data and have limited mobile functionality. Some EHR systems incorporate chat functionality, but only support basic text chat and calls. They are far from ideal for effective communication and collaboration.

One of the easiest ways to unlock the potential of EHRs in hospitals is to implement a clinical communication platform that can connect with the EHR and collect, collate, and deliver data in a format that can be easily used at the point of care. These platforms ensure all members of the care team can send and receive the right information, about the right patient, at the right time, even when they are not interacting directly with their EHR.

Clinical communication platforms allow patient information to be transmitted securely from the EHR, clinicians can receive automated critical alerts, and through integration with scheduling systems, messages can be sent to the correct on-call physicians and nurses. In contrast to EHRs, which can only be accessed by licensed users, clinical communication solutions can be used by all members of the care team and affiliates. They can also be used to communicate with patients. The platforms support text messaging, voice and video calling and allow medical images and files to instantly be shared with authorized users. Thanks to open APIs, the solutions are fully interoperable with virtually all hospital systems, unifying those systems and healthcare communication.

One success story from adopting such as solution comes from Waterbury Hospital in Connecticut, a 357-bed hospital with more than 2,000 employees. The hospital uses a Cerner EHR, which generates notifications based on patient data in the system. However, making sure clinicians received timely notifications about patients, such as when test results are ready, was a challenge.

By implementing a communications and collaboration platform developed by TigerConnect, and integrating that system into the EHR, notifications could automatically be routed to clinicians’ mobile devices, wherever they are located. After implementing the system, Waterbury Hospital was better able to engage with community physicians and instantly notify care teams about consult requests, lab test results, completed medical imaging, and vital sign thresholds indicating septic infection, helping to improve quality of care, patient safety, and throughput and significantly accelerating response times.