EHR’s need common language with multiple accents


Going down the rabbit hole that is health care information exchange, we are often faced with a common question: Is the goal for health care interoperability to have all doctors and hospitals use the same, single electronic records system (EHR)? Would that be the easiest way to accomplish freedom of information movement and achieve all the benefits a robust system should possess (lack of testing and procedure duplication among providers, ease of global search, clinical decision support, etc)?

The answer is a resounding YES! That would be much easier. But it is also a meeker sounding no. Of course if everyone used the same records system, the world of health information exchange would be an easier place. Much like finding parts for your car would be simpler if there were only one brand, model and color of automobile. For the software engineers, it would be a level playing field with great ease of implementation. The loss would be to the clinicians — and ultimately to the patients.

Lack of differentiation in the user experience (UX) puts round pegs into square holes. Forcing a cardiologist to use the same system that works well for a chiropractor would be a detriment to  workflow. The patient encounter and data capture requirements are dramatically different. The importance of subsets of the examination and test tracking differ. The clinician would be slower and the quality of care would likely suffer. The patient would be worse off even as the data forest strengthens and aligns.

What is required is not the use of a single EHR but a single language of data interchange. Meaningful Use Stage 1 regulations brought us the CCD, Continuity of Care Document, which took steps to improve data flow exchange. However, we learned that the CCD isn’t really the complete problem solver it might appear to be. A lack of specificity and optional sections left holes in the dataflow.

The next step comes with Meaningful Use Stage 2: the Consolidated-Clinical Document Architecture (C-CDA); another positive push toward interoperability. This allows clinical summaries and consult notes in an easier to parse format with consistent headers. Still complex gaps in the translation and integration process that need to be ironed out, but closer to a universal language albeit colored with individual clinical accents.

The standards come down to restraints: force users to put as much information about a patient’s health into ones and zeros, checkboxes and pulldown menus and as little as possible into the once gold standard of clinical narrative. Think: fewer words, more structured data sets. Less creativity but easier sharing capabilities.

Overall, the system is moving in the right direction. There is much work to be done, which is exciting for those of us who want to help in the transition to full interoperability with the ultimate goal of increasing quality of health care while reducing costs and medical errors.

Dr. Brett Kinsler is an evidence based chiropractor in Rochester, NY and a certified healthcare technology specialist.


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