Interoperability is Harder Without a Complete Patient Chart

on Tuesday, 06 January 2015. Posted in Healthcare Deployment

The now ex-National Coordinator for Health IT, Karen Desalvo, recently spoke at a conference about how interoperability won’t be easy. I’m sure we can pretty much regard that as an understatement. Interoperability continues to be a challenge within hospitals and systems with evolving standards, varying levels of IT adoption, and the current M&A environment. Not to mention the struggles that many providers have with their application vendors in terms of upgrades and professional services. Add in clinical workflow changes to accommodate interoperability and security concerns and you can see how difficult achieving interoperability will be.

However, if we continue to think about interoperability as a basic foundation for improving population health then there is something else for us to consider on the path to interoperability. Do we have all the data we need in our EMR? Having a complete, actionable patient chart, at the point-of-care, dramatically improves care coordination for individual patients. However, it also has a dramatic impact on quality of care as patients transition between care settings and as data for analytics and clinical decision support become more available.

As we continue to work with healthcare customers to identify, integrate and create actionable data, here are a few thoughts on common culprits for where data often hides and prevents us from having a complete, working patient chart:

  • Paper-based data - there are still plenty of paper processes that happen just within a hospital. Not to mention across medical trading partners within the same system. This includes everything from scanning to faxes. Identifying and bringing that paper into the EMR as structured data is critical.
  • Unstructured data - just because we have data in the EMR doesn't mean it’s searchable and available for use in analytics. Dictation files, smartphone pictures from the ER, etc. It’s great to have this data in the patient chart but if it’s not actionable by the clinical staff then we’re not taking advantage of having the data in the first place.
  • Machine data - data is constantly being captured by patient monitoring tools like vents, blood pumps, monitors, etc. Integrating that data into the patient chart can give clinical staff a real-time view of the patient’s vitals and help make critical decisions in their care plan.
  • Legacy data and applications - Within any hospital on average 30% of the applications in the environment are either being duplicated by another system or are going unused. Putting aside the cost burden of paying support and maintenance of those applications, the patient data is trapped in those databases and not being actively used by the front line systems in place today. Having a plan for migrating the data into actively used applications and decommissioning those systems is a step in the right direction.

Interoperability won’t be easy. However, having a complete patient record is a major step forward in capturing and managing the required data in order to make the best, real-time clinical decisions. If you know where to look, the data is already there.