The dream of a robust, interoperable EHR (Electronic Health Record) begins and ends with simple standards. Logic would tell us that if we all just implement using the same standards, then all of our EHR/PHR (personal health records) software systems could just discover each other and interoperate, providing us a way to:

  • Find other organizations’ services
  • Establish secure communications with other organizations
  • Search for a patient
  • Search for a patient’s data
  • Transfer a patient’s data
  • Comply with HIPAA/Privacy Act and other regulations governing the sharing of health data
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The Reality

Although the health IT community has made great strides in the last decade, there is a long way to go before we a see a working longitudinal EHR. The reality is that if you step on a rusty nail in 2016, neither you nor your Doctor have a reliable place to search for your last tetanus shot across all the healthcare organizations that have treated you. A poll conducted by Medical Practice Insider concluded that more than 60 percent of doctors do not consider their current EHR a worthwhile investment. We are all patients—why is it not yet possible to pull together a decent cross-organization listing of our personal healthcare records?

The Department of Defense’s current EHR design supports certificate-based trust with centralized lookup, similar to how online banking works. That means that Organization A has a single place to find all the services out there, and a signed certificate to authorize the use of those services. All of the actual interoperability comes from following standards so that when Organization A’s software looks up Organization B’s software and gets that secure and encrypted communication channel established over the internet, then they are speaking the same language ­- aka ‘Standards’!

However, we begin to run into problems because:

  • Standards are overly complex and ambiguous – Chosen standards are so ambiguous and complex that no two people are likely to implement them the same way. Implementation guides have come out, but it starts to look like the tax code—complexity stacked on top of complexity to reduce complexity.
  • Standards are good, but no magic bullet: TEST! – Web standards like HTML, CSS, and JavaScript are some of the most mature and widely used standards out there today. However, even those established standards will not work for a web app if you do not test the app in every browser.  Similarly, health data services based on health IT standards, almost always require point-to-point testing and tweaking between healthcare organizations looking to share data. While testers can easily obtain most major web browsers, most of your sharing partners’ EHR software like Epic, Cerner, eClinicalWorks and many others are not readily available.

So What Do We Do?

Standards are not the enemy of the healthcare interoperability dream. However, they need to be modified—reduced down, simplified, and made intuitive enough for people to understand them without having to refer to reams and reams of documentation and implementation guides. The best way to increase the odds that your web-based EHR works across all browsers is to use an underlying standard that is as simple as possible.  FHIR (Fast Healthcare Interoperability Resources) URLs and payloads, if kept simple enough, could allow software products and components to work without always requiring point-to-point testing to iron out kinks. Again, simplicity is key here. A viable EHR across organizations could improve patients’ experience, reduce costs, and improve the quality of care. It is a good dream!

Ellumen, Inc. is a certified small business that specializes in a variety of federal healthcare IT and communications areas, from systems training to medical imaging technology. Contact us or view our services page to learn more.