Monday, March 1, 2010

EHR's--Up in the Air

As a frequent flyer with more than 2 million miles in my account, I often find myself sitting alongside fellow road warriors. On my past two trips, I was seated beside EHR consultants that were implementing systems in different parts of the U.S. They shared that the demand for EHRs was so great that they were struggling to manage the workload. 

Conversations such as this with fellow IT professionals lead me to believe that institutions are finally biting the bullet and getting onto the EHR bandwagon. In addition, I've heard that more facilities are adding cross-enterprise interconnectivity requirements to their RFP's, mostly in the form of support for the cross-enterprise document sharing (XDS) profile for their PACS and EHR systems. As reported in last month's column, industry has embraced this effort with more than 50 percent of the participants at the 2010 IHE Connectathon testing their compliance with the profile. 

One big question remains: Are we ready? Do all physicians have the proper infrastructure to access EHR's and PHR’s? Do they have the training to use these systems? Are they aware of the scope of what is required for a successful implementation? Are their systems properly configured for archiving and backup? Lastly, is security in place to safeguard patient data? 

As EHRs proliferate, so does the risk for misuse and unauthorized access. I would be the last person to argue that this should be a reason to slow down the roll-out of these systems; however, I would be the first to argue that we have an enormous basic IT and EHR training requirement that has to be met. 

The other big question is whether or not the systems being installed have the proper interfaces to communicate with one another? It is fine for them to be CCHIT compliant, so we have some idea about the provided functionality; however, what about certifying them against an interconnectivity and interoperability specification? If we don't insist on this basic requirement, we'll only end up with more systems that don’t talk with one another, something we want to avoid. 

For example, we have two major healthcare providers in the Dallas metropolitan area, both of which are implementing their own EHR. Not surprisingly, if I go the ER in the hospital immediately to the north of where I live they won’t be able to access the information from the hospital on the south side of my town. An interoperability requirement is desperately needed. 

How will the next few years develop in regard to EMR/EHR implementations? I predict a many new issues will arise, there will be some spectacular failures, and a lot of money will be spent unnecessarily due to inadequate training and a lack of standard requirements. There will be a lot of consultants very busy for many years to come, and I'm sure I’ll be hearing some interesting stories while I'm up in the air. 

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