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.


Do you do the RHIO?


Perhaps you’ve heard the term before. Perhaps not. RHIO (ree-yo) stands for Regional Health Information Organization and is a way for multiple providers and health care organizations to share data in a common way. The goal is to facilitate rapid and standardized exchange of patient information. Our office joined the Rochester RHIO which gives us access to the hospitals, laboratories and radiology centers in a 13 county region.

From the first day, our patients noticed the benefit. We were able to quickly obtain lab results that were ordered by another doctor, get imaging results from years back and check on the discharge instructions from a recent emergency department visit. All with minimal interruption to our office workflow. All of these things were obtainable in the past but each required a separate phone call from a staff member and, when a patient couldn’t recall exactly which lab or center performed their test, often multiple calls were needed.

It is easy to see that RHIOs should help in reduction of test duplication, decrease staff hours in tracking down results and providing patients safer care but transferring allergies and medical history to each provider. The organization in the Rochester area has no cost to providers (including chiropractors) but your mileage may vary.

It’s not without it’s weaknesses. Currently, the Rochester RHIO doesn’t have accurate patient insurance information and individual providers cannot upload data. So, if we write a report for a patient from our chiropractic office and discuss the treatments we delivered for a herniated disc, for example, there is no way for us as an individual provider to submit that to the system. Yet. For the moment, we are consumers of the data and not producers. This is a weakness but I imagine it won’t be for long.

If you are a medical doctor or chiropractor in the Rochester, NY area, I strongly urge you to contact our local RHIO ( and if you are a practitioner in another part of New York State, you can check this clickable map to see if there is a RHIO you can join in your region:

Wondering if there is a RHIO in your state? Check with the local hospital’s IT or HIM (Health Information Management) department. They should know if there is a current network or one in the planning stages. The transfer of health information across multiple organizations is one of the most important aspects of healthcare and one that benefits providers, patients, hospitals and the communities.


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

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