Group Therapy: Discussing EHR Interoperability

October 13, 2009
Sean Johnson

Electronic Health Records – the three words that you’ve probably heard a billion times. They are the words that lead to other words that you hear over and over again: incentives, penalties, integration, etc. Many physicians admittedly hesitate to implement an EHR in their practice for numerous reasons. But aside from the big ones, such as cost, security, and the time it takes, there’s one major barrier – interoperability.

Electronic Health Records — the three words that you’ve probably heard a billion times. They are the words that lead to other words that you hear over and over again: incentives, penalties, integration, etc. Many physicians admittedly hesitate to implement an EHR in their practice for numerous reasons. But aside from the big ones, such as cost, security, and the time it takes, there’s one major barrier – interoperability. Without interoperability, an EHR’s usability is limited. It will only be a matter of time before a practice or physician will have to rip out a system and pay for and implement a new one if their EHR cannot communicate with non-native, similar systems. Unfortunately, right now, there isn’t really an answer, and this lack of interoperability leads to the craft presentation title, “Why Can’t We All Play in the Sandbox Together?”

Cindy Dunn was upfront with the attendees in this presentation from the very beginning; she blatantly stated that she does not have the solution to interoperability. Rather, this session was meant to share experiences and hopefully pass along some information that will prevent physicians from wasting time making similar mistakes in the future. (It was also a nice opportunity for Dunn and fellow presenter Debra Wiggs to plug MGMA’s SwipeIT project again. This is a very interesting project that I mentioned in a posting yesterday — if you have not checked out this project, please do so. It aims to provide patients with ATM-like cards that pre-populate all of their medical information with a quick swipe at the doctor’s office.)

Prior to digging into the issues with interoperability, Cindy Dunn insists that physicians in the audience who have EHRs go home from the MGMA conference and immediately ask their vendor to do a back-up scan of all their medical records. She goes on to refer to clients she has worked with who had always done their due diligence to backup their records but never actually had their vendor do a check on them. Turns out one of her clients had four years worth of blank records. Naturally, she also mentioned events like hurricanes and flash floods, which contain the power to wipe out a practice’s entire record bank (we all know the terrible effects that Katrina had). Because of these instances, it’s important for physicians to actually see their backup records.

Ok, onto interoperability — kind of. This session instead has evolved into an open discussion about physicians’ experiences with interoperability and the lack of interoperability. Cindy Dunn shares two incredible anecdotes about physicians who carelessly allowed breaches of records, due in part because of interoperability lacking security:

1) A woman goes in for blood work and wants to know the results, so she calls her physician’s office days later. The doctor is not in the office that day, but his admin goes ahead and accesses the patient’s record. Even worse, she grants access to the record to the woman, who is worried about the results. She find out that she’s being referred to get some follow-up procedures, so she goes ahead and makes the appointments herself, unbeknownst to the doctor. The physician comes in on Monday and realizes that the follow-up procedures have been ordered and throws a fit. He is written up and penalized with heavy fines, although Dunn does not elaborate on this.

2) Another doctor realizes his ex-wife has scheduled an OB/GYN appointment with a colleague who shares an open source network of records. Simply put, he has access to his colleague’s records, and goes in to find out that his ex-wife is pregnant before her husband even knows. He is also written up and fined.

These examples lead to a 30-minute open floor discussion in which physicians in the audience give their experiences. One gentleman said that he is currently in a system like the physicians in example #2, where he has access to the records of patients that are not his and that he feels uncomfortable about that. Rightfully so — it only takes one mistake to leave your digital fingerprint where it should not be.

The session continues on like this until time runs out. Although it wasn’t much of an informative presentation, it did provide value to physicians in a group therapy kind of way. The only thing that was missing was a large couch and Michael Jackson’s “You Are Not Alone” playing in the background.

The bottom line is this — physicians have enough on their plate in terms of all the rules and regulations they need to meet, especially technologically speaking. Because EHR systems, for the most part, still lack the ability to communicate broadly with other similar systems, physicians have a major headache on their hands. The government wants them to jump into all this technology, but what happens when, two or three years down the road, physicians need to start over…again? If you know the answer, I know a bunch of people who would like to know.