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Paper or Electronic – Does Physician Age Matter?

Posted on February 13, 2015 I Written By

The following is a guest blog post by Jennifer Della’Zanna, medical writer and online instructor for Education2Go.
Jen - HIM Trainer
During the Annual Meeting of the Office of National Coordinator for Health Information Technology (#ONC2015), one of the presenters commented that the new generation of doctors have never seen a paper chart, and they have fundamentally different views about what an electronic health record can do compared to clinicians who worked with paper charts for most of their careers. I was inclined to agree and thought it would be fun to find out what those differences are. Luckily, I have access to doctors of all ages, so I decided to conduct a very non-scientific investigation.

My first victims—er—test subjects happened to be my daughter’s pediatrician and a resident on his rotation. Who could ask for a more perfect situation to test this theory? She was a young resident, and he has been a physician since before I was born. I was surprised, therefore, to hear the same complaints about what was wrong with the electronic health record from both and no real answers for what they expected from an EHR. Neither were afraid of technology in and of itself, so I considered that factor controlled. Their complaints? The cut/paste feature allows too many errors through (and they had many real-life examples), alert fatigue, and the narrative portions are too long to scroll through. They get hung up on the mistakes and then decide they can find out more, and more quickly, if they just ask the patient for the information again.

Alright, he actually said he hated it, and she didn’t say that, but that was about the only difference. Ideas for what they’d want instead or how the technology should work? Not so much—from either one.

A trauma surgeon friend at Geisinger Medical Center in Pennsylvania recalled her experiences when they first installed an EHR in her hospital. She hated it. You have never seen such hate as when she recalls her first interactions with the system. She is a vocal sort and, eventually, the hospital said to her that they had an opportunity to customize the system to their hospital and asked if she would serve on the consulting committee. She protested that she knew nothing about computers. They told her they didn’t want somebody who knew about computers. They wanted somebody who had definite opinions about how the system could improve clinical workflow.

My friend said yes. Today, she says she can’t imagine practicing medicine without the EHR. She says it makes her a better doctor. For the record, my friend started out in a paper environment, switched to the EHR, but is not really tech savvy at all.

I checked in again with her recently and asked if she saw any real difference between how older docs and her residents use the system. She said that the older docs use it to get information, and the younger docs do things with it. “That’s the reason for the resident minion,” she says. The older docs get their information from the system and tell the minion to do all the things that have to do with CPOE. She says, “I’d never be able to spell ophthalmology correctly in the system in order to get a consultation!”

She agrees that there is some alert fatigue among physicians, but she thinks it definitely keeps patients safer. She also says it’s often a love/hate relationship for most staff members, but that nobody would willingly practice without it again.

So, is adoption of and satisfaction with an EHR a function of age or technical ability or is it something else?

Perhaps it’s specialty. A pediatrician or a family practice doctor sees many different types of problems, usually has a long history with patients, and may have an electronic record much like the old paper records. I’m sure you’ve seen those thick files, bulging with years’ worth of reports and letters and hand-written charts. It seems that the electronic record, in those cases, may be no better than an electronic form of a paper chart. A trauma surgeon, on the other hand, sees a patient for a short period of time, has less information that requires review, probably makes full use of clinical decision tools but hears very few alerts to make decisions about. The patient is seen, operated on, and discharged to another practice (where they have to slog through the narrative details of the patient’s hospital stay).

More likely, EHR satisfaction is simply a matter of not realizing the advantages we have in front of us because of the difficulties we still focus on. Back when the only option was a paper chart, there were plenty of complaints about those, too. At least we no longer have to deal with doctors’ handwriting (and my friend made the case for me about why doctors have such bad handwriting—they can’t spell—but that’s another story).

Are there problems with EHRs that could still stand some fixing up? Of course there are. But, if you had an honest discussion with yourself about whether you’d prefer going back to paper charts, what would your answer be?

Maybe it’s time to crowdsource solutions instead of complaining about the products as they stand today. What do you expect from your EHR, and how can you be part of the solution? By the way, there is one critical element about people who’ve worked with paper charts and those who haven’t—their expectations and ideas about EHRs are equally important!

What’s been your experience with EHR use and the impact of a physician’s age?

About Jennifer Della’Zanna
Jennifer Della’Zanna, MFA, CHDS, CPC, CGSC, CEHRS has worked in the health care industry for 20 years as a medical transcriptionist, receptionist, medical assistant, practice administrator, biller and coding specialist. She has written and edited courses and study guides on medical coding and the use of technology in health care, and she is an associate editor for Plexus magazine. She teaches medical coding, transcription and electronic health record courses and regularly writes feature articles about health issues for online and print publications. Jennifer is active in preparing for the industry transition to ICD-10 as a trainer for the American Academy of Professional Coders (AAPC). You can find Jennifer on Facebook and Twitter.

HIPAA Compliance and Windows Server 2003

Posted on February 12, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Last year, Microsoft stopped updating Windows XP and so we wrote about how Windows XP would no longer be HIPAA compliant. If you’re still using Windows XP to access PHI, you’re a braver person that I. That’s just asking for a HIPAA violation.

It turns out that Windows Server 2003 is 5 months away from Microsoft stopping to update it as well. This could be an issue for many practices who have a local EHR install on Windows Server 2003. I’d be surprised if an EHR vendor or practice management vendor was running a SaaS EHR on Windows Server 2003 still, but I guess it’s possible.

However, Microsoft just recently announced another critical vulnerability in Windows Server 2003 that uses active directory. Here are the details:

Microsoft just patched a 15-year-old bug that in some cases allows attackers to take complete control of PCs running all supported versions of Windows. The critical vulnerability will remain unpatched in Windows Server 2003, leaving that version wide open for the remaining five months Microsoft pledged to continue supporting it.

There are a lot more technical details at the link above. However, I find it really interesting that Microsoft has chosen not to fix this issue in Windows Server 2003. The article above says “This Windows vulnerability isn’t as simple as most to fix because it affects the design of core Windows functions rather than implementations of that design.” I assume this is why they’re not planning to do an update.

This lack of an update to a critical vulnerability has me asking if that means that Windows Server 2003 is not HIPAA compliant anymore. I think the answer is yes. Unsupported systems or systems with known vulnerabilities are an issue under HIPAA as I understand it. Hard to say how many healthcare organizations are still using Windows Server 2003, but this vulnerability should give them a good reason to upgrade ASAP.

Are Changes to Meaningful Use Certification Coming?

Posted on February 10, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’d been meaning to write about the now infamous letter from the AMA and 20 other associations and organizations to Karen DeSalvo (ONC Chair and Assistant HHS Secretary). I’ve put a list of the organizations and associations that co-signed the letter at the bottom of this post. It’s quite the list.

In the letter they make these recommended changes to the EHR certification program:

1. Decouple EHR certification from the Meaningful Use program;
2. Re-consider alternative software testing methods;
3. Establish greater transparency and uniformity on UCD testing and process results;
4. Incorporate exception handling into EHR certification;
5. Develop C-CDA guidance and tests to support exchange;
6. Seek further stakeholder feedback; and
7. Increase education on EHR implementation.

Unfortunately, I don’t think that many of these suggestions can be done by Karen and ONC. For example, I believe it will take an act of Congress in order to decouple EHR certification from the meaningful use program. I don’t think ONC has the authority to just change that since they’re bound by legislation.

What I do think they could do is dramatically simplify the EHR certification requirements. Some might try to spin it as making the EHR certification irrelevant, but it would actually make the EHR certification more relevant. If it was focused on just a few important things that actually tested the EHR properly for those things, then people would be much more interested in the EHR certification and it’s success. As it is now, most people just see EHR certification as a way to get EHR incentive money.

I’ll be interested to see if we see any changes in EHR certification. Unfortunately, the government rarely does things to decrease regulation. In some ways, if ONC decreases what EHR certification means, then they’re putting their colleagues out of a job. My only glimmer of hope is that meaningful use stage 3 will become much more simpler and because of that, EHR certification that matches MU stage 3 will be simpler as well. Although, I’m not holding my breathe.

What do you think will happen to EHR certification going forward?

Organizations and Associations that Signed the Letter:
American Medical Association
AMDA – The Society for Post-Acute and Long-Term Care Medicine
American Academy of Allergy, Asthma and Immunology
American Academy of Dermatology Association
American Academy of Facial Plastic
American Academy of Family Physicians
American Academy of Home Care Medicine
American Academy of Neurology
American Academy of Ophthalmology
American Academy of Otolaryngology—Head and Neck Surgery
American Academy of Physical Medicine and Rehabilitation
American Association of Clinical Endocrinologists
American Association of Neurological Surgeons
American Association of Orthopaedic Surgeons
American College of Allergy, Asthma and Immunology
American College of Emergency Physicians
American College of Osteopathic Surgeons
American College of Physicians
American College of Surgeons
American Congress of Obstetricians and Gynecologists
American Osteopathic Association
American Society for Radiology and Oncology
American Society of Anesthesiologists
American Society of Cataract and Refractive Surgery and Reconstructive Surgery
American Society of Clinical Oncology
American Society of Nephrology
College of Healthcare Information Management Executives
Congress of Neurological Surgeons
Heart Rhythm Society
Joint Council on Allergy, Asthma and Immunology
Medical Group Management Association
National Association of Spine Specialists
Renal Physicians Association
Society for Cardiovascular Angiography and Interventions
Society for Vascular Surgery

6 Healthcare Interoperability Myths

Posted on February 9, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

With my new fascination with healthcare interoperability, I’m drawn to anything and everything which looks at the successes and challenges associated with it. So, it was no surprised that I was intrigued by this whitepaper that looks at the 6 Healthcare Interoperability Myths.

For those who don’t want to download the whitepaper for all the nitty gritty details, here are the 6 myths:

  1. One Size Fits All
  2. There Is One Standard to Live By
  3. I Can Only “Talk” to Providers on the Same EHR as Mine
  4. If I Give Up Control of My Data, I’ll Lose Patients
  5. Hospitals Lead in Interoperability
  6. Interoperability Doesn’t Really “Do” Anything. It’s Just a Fad like HMOs in the 90s

You can read the whole whitepaper if you want to read all the details about each myth.

The first two hit home to me and remind me of my post about achieving continuous healthcare interoperability. I really think that the idea of every health IT vendor “interpreting” the standard differently is an important concept that needs to be dealt with if we want to see healthcare interoperability happen.

Another concept I’ve been chewing on is whether everyone believes that healthcare interoperability is the right path forward. The above mentioned whitepaper starts off with a strong statement that, “It’s no tall tale. Yes. We need interoperability.” While this is something I believe strongly, I’m not sure that everyone in healthcare agrees.

I’d love to hear your thoughts. Do we all want healthcare interoperability or are there are a lot of people out there that aren’t sure if healthcare interoperability is the right way forward?

Why No Disclosure of Financial Relationships with KLAS When You Win Best in KLAS?

Posted on February 6, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This week I’ve been inundated with press releases and companies promoting their Best in KLAS ranking/rating (whatever you want to call the award). In fact, I’ve gotten so many notices from so many healthcare IT companies, it prompted to me to send the following tweet:

Ironically, that tweet was before I got another dozen more press releases, blog posts and tweets informing me of how great their company is because they’re “Best in KLAS.”

In a conversation I had with someone who was “Best in KLAS” and when I saw a blog post by a CEO that was so proud of their Best in KLAS rating, I wondered why we don’t have some expectation of financial disclosure with these type of ratings and awards. This isn’t an issue for KLAS alone, but would apply to Gartner and a number of other organizations that offer these type of healthcare IT software ratings.

In the blogging and media world, the topic of disclosing financial interests is often discussed. It’s a policy that I follow myself. If I ever write about a company for which I have a financial relationship (advertiser, sponsored content, email campaigns, etc), I disclose that financial relationship in the article. I believe it’s important for anyone reading that article to know that there’s a financial relationship which could sway the content.

Shouldn’t we expect the same from companies who have a financial relationship with these ratings organizations? There’s a possibility that the financial relationship could have made a difference in those ratings. Shouldn’t we know about this potential for bias?

Of course, I don’t expect we’ll see many organizations take me up on this idea that they disclose their financial relationship. So instead, I’m calling on those Best in KLAS companies who don’t have a financial relationship with KLAS to come forward and disclose that they don’t have a financial relationship with KLAS and they still were given a Best in KLAS rating. I’ll be interested how many come forward.

As I’ve long told people who ask me about the value of KLAS, I think there’s so many ways to skew their results that I don’t put much value in their results. Plus, I’m not sure about their methodologies which include doing ratings at EHR user conferences (biased sample anyone?).

However, for marketers, I tell them they absolutely should make the most from a Best in KLAS rating. Most healthcare organizations don’t understand (likely because they’re too busy) the nuance in proper ratings and therefore blindly use KLAS for their decision making. Unfortunately in healthcare IT, these people don’t have any other choice but KLAS. So, given no better alternative, it’s no surprise that they use what’s available.

Of course, my hope is that most healthcare organizations use KLAS, Gartner magic quadrants and whatever other ratings and rankings that exist as just another data point. Triangulating across those and your colleagues is often going to lead people to the best solution.

Full Disclosure: I have an affiliate partnership with a company Gartner bought for some EHR lead generation. I’m sure they’ll love this article.

Will Hospitals Be At Risk for HIPAA Audits If They Don’t Have HIPAA Violations?

Posted on February 5, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Sutter Health’s California Pacific Medical Center (CPMC) recently announced an employee accessing patient files without a business or treatment purpose. Here are the details from their press release:

California Pacific Medical Center (CPMC) recently notified 844 patients of its discovery that a pharmacist employee may have accessed their records without a business or treatment purpose.

CPMC first learned of the incident through a proactive audit of its electronic medical record system on October 10, 2014. The initial audit resulted in identification and notification of 14 individuals on October 21, 2014. Following its policy, CPMC terminated its relationship with the employee and broadened the investigation

The expanded investigation identified a total of 844 patients whose records the employee may have accessed without an apparent business or treatment purpose. It is unclear whether all of these records were accessed inappropriately but, out of an abundance of caution, CPMC notified all of these patients.

This was a fascinating breach of HIPAA. In fact, it starts with the question of whether we should call this a breach. In the HIPAA sense, it’s a breach of HIPAA. In the IT systems security sense, I could see how people wouldn’t consider it a breach since the person didn’t visit anything he wasn’t authorized by the IT system to see. Semantics aside, this is a HIPAA issue and is likely happening in pretty much every organization in the US.

My last statement is particularly true in larger organizations. The shear number of staff means that it’s very likely that some users of your IT systems are looking at patient records that don’t have a specific “business or treatment purpose.” I’m sure some will use this as a call for a return to paper. As if this stuff didn’t happen in the paper world as well. It happened in the paper world, but we just had no way to track it. With technology we can now track every record everyone touches. That’s why we’re seeing more issues like the one reported above. In the paper world we’d have just been ignorant to it.

With this in mind, I start to wonder if we won’t see some HIPAA audits for organizations that haven’t reported any violations like the ones above. Basically, the auditors would assume that if you hadn’t reported anything, then you’re probably not proactively auditing this yourself and so they’re going to come in and do it for you. Plus, if you’re not doing this, then you’re likely not doing a whole slew of other HIPAA requirements. On the other hand, if your security policies and procedures are good enough to proactively catch something like this, then you’re probably above average in other areas of HIPAA privacy and security. Sounds reasonable to me. We’ll see if it plays out that way.

The other lesson we need to take from the above HIPAA breach notification is that we shouldn’t be so quick to judge an organization that proactively discovers a breach. If we’re too punitive with healthcare organizations that find and effectively address a breach like this, then organizations will stop finding and reporting these issues. We should want healthcare organizations that have a culture and privacy and security. Part of that culture is that they’re going to sometimes catch bad actors which they need to correct.

Healthcare IT software like EHRs have a great ability to track everything that’s done and they’re only going to get better at doing it. That’s a good thing and healthcare information security and privacy will benefit from it. We should encourage rather than ridicule organizations like the one mentioned above for their proactive efforts to take care of the privacy of their patients’ information. I hope we see more organizations like Sutter Health who take a proactive approach to the security and privacy of healthcare information.

An EHR Focused On Customer Requests, Not MU

Posted on February 4, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I love taking email exchanges I have with practicing doctors and making their comments into posts. This is one of those cases. The following is a quote from an email I got from a physician friend of mine about his EHR (EHR name removed):

Every time we turn around these days our EHR vendor is adding some new update. Sometimes the updates change the format of how the system appears and functions, sometimes they don’t. Unfortunately, the people who are still chasing after all the crazy government hoops to jump through and those who are not are all forced to deal with the same EHR software system. I really wish there was a separate system with no crazy upgrades that would function the same way that the system did two years ago. That was a much simpler and more commonsensical system. It’s a really sad case of the government says jump and software systems say how high?

I believe this physician has stopped taking Medicare patients and has happily avoided meaningful use. However, as the above comments illustrate, he hasn’t avoided a lot of the impact that meaningful use has had on the design of his EHR system. Plus, that doesn’t even count all the great new features that this doctor could have gotten from his EHR if they weren’t busy turning on all the MU requirements including the MU reporting and tracking.

His comments about wanting a system that isn’t influenced by MU requirements is quite interesting since Pri-Med (the company that acquired Amazing Charts) has announced an EHR product called InLight EHR that’s not certified and doesn’t do MU. The press release says the EHR is designed for Direct Primary Care. This is a really interesting move by them, and my doctor friend above illustrates why an EHR software that’s not MU certified could work.

One challenge to this idea is that a lot of doctors can’t shun Medicare and meaningful use. So, they’ll need to continue with the EHR that are still chasing the government carrot and avoiding the stick. We’ll see how these different EHR markets evolve.

Crowdfunding Medical Bills

Posted on February 3, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I recently had a friend send over a Give Forward campaign for the Faul Family Recovery Fund. I don’t know the family, but they have three autistic children and one fo the daughters has a severe congenital heart defect. To top if off, the Father is autistic and suffers from depression and lost his job thanks to these health challenges. Such an amazing situation.

It’s no wonder that this family is having financial challenges and needs people to support their GiveForward campaign. We’ve all heard that medical bills is the #1 source of bankruptcy in the US. It’s expensive to get the treatment you need when you have a chronic illness.

With that said, I’m really intrigued by these crowd funding platforms that help people like the Faul Family raise money from family, friends and other caring people in order to help cover their medical expenses. The campaign I mentioned has currently raised $4,225 and they’re trying to raise $25,000. That’s not a small sum of money, but is much more manageable when a crowd of caring people are all contributing their Starbucks money to someone in need. The site has raised nearly $150 million this way. That’s amazing!

While Give Forward can be used for a lot of things, the medical category seems to dominate. A look through the medical category puts a face, a name and a story to healthcare in a way that those outside of healthcare rarely see. Walking through the list is both expiring and heart wrenching. Something that those on the front lines of healthcare see every day.

As someone who writes about healthcare, IT, and social media I’m really intrigued by the crowdfunding of medical bills. No doubt it’s a lifesaver for so many involved and likely gets a lot of doctors and hospitals paid that would otherwise get paid. I think those are great things. Plus, I think there’s value to all of us to give of ourselves to others.

I guess I just wonder if this will become a predominant model or how this model will evolve over time. Every hospital in the nation has stories like this walking through their doors every day. Should healthcare organizations be partnering with these crowdfunding platforms? Where do you think all of this is going?

How Do We Achieve Continuous Healthcare Interoperability?

Posted on February 2, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today I had a really interesting chat about healthcare interoperability with Mario Hyland, Founder of AEGIS. I’m looking at a number of ways that Mario and I can work together to move healthcare interoperability forward. We’ll probably start with a video hangout with Mario and then expand from there.

Until then, I was struck by something Mario said in our conversation: “Healthcare interoperability is not a point in time. You can be interoperable today and then not be tomorrow.

This really resonated with me and no doubt resonates with doctors and hospitals who have an interface with some other medical organization. You know how easy it is for your interface to break. It’s never intentional, but these software are so large and complex that someone will make a change and not realize the impact that change will have across all your connections. As I wrote on Hospital EMR and EHR, API’s are Hard!

Currently we don’t even have a bunch of complex APIs with hundreds of companies connecting to the EHR. We’re lucky if an EHR has a lab interface, ePrescribing, maybe a radiology interface, and maybe a connection to a local hospital. Now imagine the issues that crop up when you’re connecting to hundreds of companies and systems. Mario was right when he told me, “Healthcare thinks we’re dealing with the complex challenges of healthcare interoperability. Healthcare doesn’t know the interoperability challenges that still wait for them and they’re so much more complex than what we’re dealing with today.”

I don’t want to say this as discouragement, but it should encourage us to be really thoughtful about how we handle healthcare interoperability so it can scale up. The title of this post asks a tough question that isn’t being solved by our current one time approach to certification. How do we achieve continuous healthcare interoperability that won’t break on the next upgrade cycle?

I asked Mario why the current EHR certification process hasn’t been able to solve this problem and he said that current EHR certification is more of a one time visual inspection of interoperability. Unfortunately it doesn’t include a single testing platform that really tests an EHR against a specific interoperability standard, let alone ongoing tests to make sure that any changes to the EHR don’t affect future interoperability.

I’ve long chewed on why it is that we can have a “standard” for interoperability, but unfortunately that doesn’t mean that EHR systems can actually interoperate. I’ve heard people tell me that there are flavors of the standard and each organization has a different flavor. I’ve seen this, but what I’ve found is that there are different interpretations of the same standard. When you dig into the details of any standard, you can see how it’s easy for an organization to interpret a standard multiple ways.

In my post API’s are Hard, the article that is linked talks about the written promise and the behavioral promise of an API. The same thing applies to a healthcare interoperability standard. There’s the documented standard (written promise), and then there’s the way the EHR implements the standard (behavioral promise).

In the API world, one company creates the API and so you have one behavioral promise to those who use it. Even with one company, tracking the behavioral promise can be a challenge. In the EHR world, each EHR vendor has implemented interoperability according to their own interpretation of the standard and so there are 300+ behavioral promises that have to be tracked and considered. One from each company and heaven help us if and when a company changes that behavioral promise. It’s impossible to keep up with and explains one reason why healthcare intoperability isn’t a reality today.

What’s the solution? One solution is to create a set of standard test scripts that can be tested against by any EHR vendor on an ongoing basis. This way any EHR vendor can test the interoperability functionality of their application throughout their development cycle. Ideally these test scripts would be offered in an open source manner which would allow multiple contributors to continue to provide feedback and improve the test scripts as errors in the test scripts are found. Yes, it’s just the nature of any standard and testing of that standard that exceptions and errors will be found that need to be addressed and improved.

I mentioned that I was really interested in diving in deeper to healthcare interoperability. I still have a lot more deeper to go, but consider this the first toe dip into the healthcare interoperability waters. I really want to see this problem solved.