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| The Health Record Review by Jeff Rowe, Editor |
Did policymakers choose the wrong path?
Posted on Tue, Nov 13, 2012 - 10:06 amHow’s that country song go? “Looking for love in all the wrong places”?
If you don’t mind us channeling our inner Waylon Jennings, that’s what came to mind when we read an article about one health IT observer, who has argued that “Healthcare quality and efficiency could move forward 20 years in a matter of months if only there were true interoperability of electronic health information.”
A matter of months, eh? It’s an interesting proposition, and while we’re in no position to make such a bold claim, we’ll admit that we have wondered fairly frequently if policymakers didn’t charge off a bit prematurely with the HITECH incentive program.
After all, it’s no secret that interoperability, or the lack thereof, remains a real problem when it comes to the spread of EHRs. So why not solve that problem first and then push providers across the digital frontier?
During last week's American Medical Informatics Association (AMIA) annual conference in Chicago, the observer, sociologist Ross Koppel of the University of Pennsylvania, argued that “While the goals of Meaningful Use -- to improve the safety and efficiency of healthcare delivery -- may be noble, . . .policymakers have been too focused on EHR features and not enough on usability.”
Had policymakers paid more attention to usability, Koppel said, including interoperability and data standards, they may “have seen how health IT has been burdened by too many standards and not enough cooperation among competing technology vendors and healthcare providers.”
For example, Koppel “said that there are about 40 different ways to record blood pressure in EHRs. At least from an informatics standpoint, perhaps three of those ways are ‘proper.’”
So what of it? It’s an academic question, no doubt, given how far down the road we’ve gone with HITECH. But it seems worth asking whether we should have solved interoperability first, then promoted the implementation of EHRs.
At the very least, by looking backwards at what perhaps should have been done, we might be able to hone in on what should be done now.
Photo courtesy of Salim Virji via Creative Commons
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Comments
It is our thought that
Proven interoperability standards are available, and governance and harmonization of regional privacy laws are issues that will stymie sharing and interoperability – and are issues that are properly the jurisdiction of the federal government as it alone transcends all the regional boundaries and policies. In recent months we are starting to see openness to learning from other countries, but still too often we try to reinvent the wheel.
Recognizing the still
As emphasized in the AMA's publication 'Practical EHR,'(page 401) "EHR systems must be operable as well as interoperable." Achieving operability includes fulfilling all clinical and compliance requirements for 1)usability (i.e., matching optimal physician workflow); 2)efficiency (i.e., meeting all care and compliance requirements without wasted effort); 3)E/M compliance; 4)data integrity (i.e., documentation in the clinical record provides only individualized patient-specific and visit-specific information during every encounter); 5)and promoting the medical diagnostic process.
As emphasized in this article, it would have been optimal to establish these criteria for operability prior to launching our current initiative. However, it is essential for patient safety, as well as for the ultimate success of our EHR transformation, to establish and enforce criteria for both operability and interoperability as soon as possible. This timing would ideally indicate establishing these criteria as mandates simultaneous with the 2014 launch of the second stage of Meaningful Use criteria.
Stephen Levinson, M.D., CHCA, PCS