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Variability in Clinician Usage of EHRs Hinders Interoperability

Health system usage standards, specialty-specific conventions, and individual standards of usage are three big operational barriers to interoperability.

Healthcare interoperability depends on health IT standards

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- With the healthcare industry becoming more reliant on increasingly sophisticated information technology, interoperability challenges continue to emerge. While we often think of integration as a technology issue, business dynamics can also hinder interoperability, as we highlighted in the first installment of our interoperability gaps series.

In this installment, we’re focusing on another obstacle to integration, which is also less technical in nature but represents one of the most significant and intractable integration issues: variability in the way clinicians use the EHR.

Because technology is constantly evolving, and because of the increasing number of rules and regulations that healthcare organizations must comply with, the way clinicians use EHRs and input data can vary from institution to institution­ — and even between departments within the same hospital.

While many EHR vendors have undergone a great deal of normalization to address variances in workflows and standards of use, they still have different geneses and alternative workflow dynamics. Therefore, hospitals and health systems often encounter the following integration challenges:


1. Health system usage standards. Hospitals often encounter difficulty when trying to share or aggregate patient data outside their organization because different health systems can have different conventions for how they document. This can be relatively straightforward to handle.

For example: converting data from providers using SNOMED vocabulary into ICD-10 is a trick most organizations have mastered. However, the challenges can be much more subtle and difficult when you have individual providers and entire specialties that use the EHR differently from other providers. 

2. Specialty specific conventions. Because of the unique circumstances of specialty care, specialists sometimes use unique conventions that differ from the rest of the organization, ultimately impacting the way patient data is entered into an EHR, interpreted, and aggregated for population health analytics.

For example: for clinicians treating a patient with breast cancer, most of the relevant diagnostic detail tends to be captured in notes fields or in radiology files, because the ICD-10 code conveys very little useful diagnostic information. This poses a significant integration challenge for IT and informatics professionals who need to accurately aggregate diagnostic data.

3. Individual standards of use. It’s also important to consider individual physician usage of the EHR. Though an organization may have specific processes and regulations to manage workflow inconsistencies, a physician may adopt their own nuances in how they use the EHR as a way to compensate for systematic idiosyncrasies. 

While these organizational challenges may never completely go away, there are a couple of things hospitals and health systems can do to get ahead of these issues.

First, organizations should embrace interoperability as a strategic initiative. The proposed information blocking rule from the ONC and CMS may alleviate some interoperability challenges, but usability issues like the ones outlined here will persist even in the face of financial penalties. By embracing the strategy behind interoperability, organizations will likely experience higher rates of success as employees will feel more motivated to work toward the goal.

Second, health systems that are already leveraging data integration tools will need to address these differences in organizational behavior with proper employee training to ensure consistency across systems.

With the healthcare industry increasingly reliant on technology, and with technology constantly evolving, organizations are bound to run into information sharing barriers. So it is vitally important that hospitals and health systems not only implement data integration tools, but to also take further measures to embrace the strategic initiative of interoperability, and to also ensure there is organizational consistency in the way employees use and enter data into these systems.

Stay tuned for the final installment of our interoperability gaps series, where we’ll examine the technical barriers to interoperability.

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ABOUT THE AUTHOR

Lyniate partners with healthcare organizations around the globe delivering cutting-edge solutions to address interoperability challenges. Our industry-leading products, Corepoint and Rhapsody, are used by thousands of customers to send hundreds of millions of messages every day. Lyniate is committed to delivering the best interoperability solutions for healthcare organizations, from specialty clinics to large networks, from payers to vendors, and everything in between. We’re building the future of interoperability.

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