Top questions healthcare organizations must ask before choosing a new EHR in 2019
February 20, 2019
By Elizabeth Buckle
Electronic health records (EHRs) held much promise when first introduced, making it easier for providers to access patient data and serve as the foundation for improved healthcare delivery and outcomes. But now, nearly a decade since the Health Information Technology for Economic and Clinical Health (HITECH) Act incentivized their adoption, many believe EHRs have yet to reach their full potential.
Why hasn’t more progress been made? Some may attribute this to a fragmented industry, flush with competing technologies and conflicting approaches. This has prevented optimal implementation of EHRs, leaving providers and patients frustrated by the limitations they still face.
At the heart of this frustration is interoperability. In fact, a recent survey by Deloitte found interoperability is a top concern among primary care and specialty physicians, and 62 percent said they’d like their current EHR system to be more interoperable.
Many challenges remain
To alleviate these concerns, the industry has to first overcome a variety of barriers:
• Standards – Organizations tend to interpret interoperability standards differently, or do not adhere to standards-based data exchange at all. This can slow down the process of connecting systems for data sharing because there will be a required period of interpretation and mapping that is required to get both systems in sync with each other.
• Stakeholders – There are many different stakeholders who all need access to data, including the patient, ambulatory and acute care providers, home health and long-term care facilities, payers, Centers for Medicare and Medicaid Services (CMS), and potentially, other organizations or individuals. Navigating the landscape of different stakeholders and their varying needs can slow down the process of implementing a truly interoperable EHR.
• Patient Identifiers – The lack of a unique patient identifier makes it difficult to track one individual in multiple care settings. Typically, a combination of demographic criteria is used to match patients, but that often falls short. Data entry errors and lack of entered data are both common issues that cause patient matching to be a challenge and a burden.
Work is being done by multiple organizations to address these challenges. For example, the non-profit CommonWell Health Alliance is bringing together health IT companies to solve interoperability challenges and break down the legacy silos. Its goal is to foster universal access to healthcare data. Currently 17 of the top 20 EHRs are, or are in the process of getting connected to CommonWell or Carequality, which are developing platform-neutral, vendor-neutral frameworks for connecting health data networks under a common set of nationwide legal, technical and policy rules to support the trusted exchange of data. Carequality has also worked on technical and policy agreements that will enable data to flow between and among networks, platforms and geographies, much like the telecommunications industry did for linking cell phone networks.
The next step: Evaluating new EHR solutions
If your organization is in the market for a new EHR solution, there are many factors you’ll need to consider as you evaluate offerings on the market today for their ability to interoperate in the future. Here are some questions you’ll want to consider to ensure the solution you select will meet interoperability goals:
• What are your priorities for a new EHR? Not every organization will have the same needs for interoperability. It could vary by practice, specialty, reporting requirements or overall goal of the organization. For example, a practice that is on 2015-certified EHR technology and has a goal of achieving the highest possible score in the “promoting interoperability” category will want to ensure that its EHR vendor can support this goal. Another practice, though, may only want to connect with other internal software that they use on-site.
• How mature is the prospective EHR vendor in terms of interoperability? Ensuring a level of interoperability that works well for a practice really depends on proper discovery during the EHR evaluation. For example, if your practice’s main goal is to exchange data with the local hospital, you will want to ensure that the EHR vendor is capable of doing so. If you don’t qualify a prospective vendor’s ability to exchange data with the organizations you deem mission critical, your practice could continue to face the same challenges discussed above long into the future. Ideally you will want a solution that uses Health Level Seven (HL7) interfaces that support connections with other practices, hospitals, health information exchanges (HIEs), labs and immunization registries.
• Can the EHR solution support exchange of multiple forms of information? It should be capable of handling seamless data exchange in multiple formats, moving easily between diverse EHRs, practice management systems and other applications, which is becoming more important with the growth of connected consumer health-monitoring devices. Systems also should be able to handle multiple forms of information, including demographics, financial information, immunization records, appointment summaries, scheduling information, clinical data and documents, orders, test results and more.
• Is it flexible and cost-effective? Point-to-point solutions deployed on-site at a facility are pricey, hard to maintain and responsible for creating the silos that hamper interoperability. Consider centralized platforms that can be accessed securely and easily by hospitals, affiliated practices, and others involved in patient care.
While numerous initiatives – from enhanced EHR vendor offerings to industrywide consensus-building on standards and platforms – are underway, it is never too soon to start thinking about interoperability, particularly if you’re in the market for a new EHR. By asking the right questions and clearly defining your organization’s need to exchange information with other parties, you can more effectively navigate the maze and achieve the level of interoperability you desire.
About the author: Elizabeth Buckle currently serves as manager of interoperability solutions, product management at Greenway Health, a leading health information technology and services provider. In addition to being a subject matter expert for interoperability solutions in product management, Elizabeth has been a project coordinator and product analyst for interoperability. She also is a co-chair of the Deployment and Utilization Committee at CommonWell Health Alliance.
Electronic health records (EHRs) held much promise when first introduced, making it easier for providers to access patient data and serve as the foundation for improved healthcare delivery and outcomes. But now, nearly a decade since the Health Information Technology for Economic and Clinical Health (HITECH) Act incentivized their adoption, many believe EHRs have yet to reach their full potential.
Why hasn’t more progress been made? Some may attribute this to a fragmented industry, flush with competing technologies and conflicting approaches. This has prevented optimal implementation of EHRs, leaving providers and patients frustrated by the limitations they still face.
At the heart of this frustration is interoperability. In fact, a recent survey by Deloitte found interoperability is a top concern among primary care and specialty physicians, and 62 percent said they’d like their current EHR system to be more interoperable.
Many challenges remain
To alleviate these concerns, the industry has to first overcome a variety of barriers:
• Standards – Organizations tend to interpret interoperability standards differently, or do not adhere to standards-based data exchange at all. This can slow down the process of connecting systems for data sharing because there will be a required period of interpretation and mapping that is required to get both systems in sync with each other.
• Stakeholders – There are many different stakeholders who all need access to data, including the patient, ambulatory and acute care providers, home health and long-term care facilities, payers, Centers for Medicare and Medicaid Services (CMS), and potentially, other organizations or individuals. Navigating the landscape of different stakeholders and their varying needs can slow down the process of implementing a truly interoperable EHR.
• Patient Identifiers – The lack of a unique patient identifier makes it difficult to track one individual in multiple care settings. Typically, a combination of demographic criteria is used to match patients, but that often falls short. Data entry errors and lack of entered data are both common issues that cause patient matching to be a challenge and a burden.
Work is being done by multiple organizations to address these challenges. For example, the non-profit CommonWell Health Alliance is bringing together health IT companies to solve interoperability challenges and break down the legacy silos. Its goal is to foster universal access to healthcare data. Currently 17 of the top 20 EHRs are, or are in the process of getting connected to CommonWell or Carequality, which are developing platform-neutral, vendor-neutral frameworks for connecting health data networks under a common set of nationwide legal, technical and policy rules to support the trusted exchange of data. Carequality has also worked on technical and policy agreements that will enable data to flow between and among networks, platforms and geographies, much like the telecommunications industry did for linking cell phone networks.
The next step: Evaluating new EHR solutions
If your organization is in the market for a new EHR solution, there are many factors you’ll need to consider as you evaluate offerings on the market today for their ability to interoperate in the future. Here are some questions you’ll want to consider to ensure the solution you select will meet interoperability goals:
• What are your priorities for a new EHR? Not every organization will have the same needs for interoperability. It could vary by practice, specialty, reporting requirements or overall goal of the organization. For example, a practice that is on 2015-certified EHR technology and has a goal of achieving the highest possible score in the “promoting interoperability” category will want to ensure that its EHR vendor can support this goal. Another practice, though, may only want to connect with other internal software that they use on-site.
• How mature is the prospective EHR vendor in terms of interoperability? Ensuring a level of interoperability that works well for a practice really depends on proper discovery during the EHR evaluation. For example, if your practice’s main goal is to exchange data with the local hospital, you will want to ensure that the EHR vendor is capable of doing so. If you don’t qualify a prospective vendor’s ability to exchange data with the organizations you deem mission critical, your practice could continue to face the same challenges discussed above long into the future. Ideally you will want a solution that uses Health Level Seven (HL7) interfaces that support connections with other practices, hospitals, health information exchanges (HIEs), labs and immunization registries.
• Can the EHR solution support exchange of multiple forms of information? It should be capable of handling seamless data exchange in multiple formats, moving easily between diverse EHRs, practice management systems and other applications, which is becoming more important with the growth of connected consumer health-monitoring devices. Systems also should be able to handle multiple forms of information, including demographics, financial information, immunization records, appointment summaries, scheduling information, clinical data and documents, orders, test results and more.
• Is it flexible and cost-effective? Point-to-point solutions deployed on-site at a facility are pricey, hard to maintain and responsible for creating the silos that hamper interoperability. Consider centralized platforms that can be accessed securely and easily by hospitals, affiliated practices, and others involved in patient care.
While numerous initiatives – from enhanced EHR vendor offerings to industrywide consensus-building on standards and platforms – are underway, it is never too soon to start thinking about interoperability, particularly if you’re in the market for a new EHR. By asking the right questions and clearly defining your organization’s need to exchange information with other parties, you can more effectively navigate the maze and achieve the level of interoperability you desire.
Elizabeth Buckle