Enabling Interoperability in a Consolidating Healthcare Industry

By George Pappas, Chief Customer Officer, DrFirst
Twitter: @DrFirst

Over the past two decades, we’ve witnessed growing consolidation in the healthcare industry which resulted from individual hospitals and practices being purchased and combined into larger health systems and integrated delivery networks (IDN). This trend has added to the already challenging problem of interoperability to raise the barrier to high-quality care.

The combination of industry-wide adoption of EHR and EMR platforms with merged health systems, each with different EHR/EMR systems, has given rise to IDNs where a patient’s journey through the system could interact with three or more EHRs, each with their own version of the truth for the same patient. The high switching costs involved in moving all hospitals and physician groups in a system to the same EHR platform has delayed or prevented the move to single EHR platforms systemwide.

While all of these realities slowed the progress to full interoperability across the healthcare industry and created considerable barriers to care coordination within healthcare organizations, there is hope. Vendor-agnostic tools are helping to pave the way toward true and efficient interoperability.

Accuracy and Organization Matter
Meaningful Use was the initial catalyst for hospitals to implement EHRs and rapidly digitize clinical information. EHRs have provided many benefits, yet they still have allowed many gaps in data and process to remain unaddressed. One of these is free text for clinical data that needs to be actionable within the system. Another is managing conflicting information from different sources that is needed by clinicians who are providing care.

This opened the door for patients to be inadvertently harmed because EHR clinical decision support rules were unable to detect and trigger alerts from free text, inaccurate patient med lists, and inaccurate physician orders. Some examples of this include medications that had been stopped a year ago were suddenly resumed, or medications that needed to be continued that were not identified and administered.

Since prescription sigs are often loaded into the EHR and stored as unstructured data, medication history and reconciliation are excellent examples of how free text within EHRs can cause care collaboration and information-sharing challenges between members of the care team.

Unstructured, free-text data makes accurate medication reconciliation almost impossible. For medication reconciliation and information collaboration to be effective and verifiable, it needs to be organized in discrete fields.

The University of Michigan performed a study of 500,000 e-prescriptions to determine accuracy of the sigs and possibility of safe delivery. Eighty-four percent of these prescriptions needed editing – that’s more than 400,000 e-prescriptions. Due to issues of interoperability, pharmacists needed to manually transcribe and review these prescriptions – looking for missing pieces of information and errors – in order to print labels, instructions, and ensure that patients could take their medications safely.

At DrFirst, we began looking at the quality of the information as it entered these systems and found significant issues. A quality sig is one that is totally complete, as the provider intended. Before manual editing by the pharmacist, 51.4% of the e-prescriptions contained at least one quality issue. After being edited manually, 11.3% still contained at least one error. And, illustrating how errors can occur with manual intervention, 1% of the time an e-prescription that did not originally contain any errors obtained an error in the manual entry process.

This evidence of incomplete and incorrect sigs being shared across the care team illustrates how unstructured and free-text data are creating inefficiency and increasing risk. And while this is a problem for any hospital or provider, it’s a serious issue for large healthcare organizations with multiple EHRs.

Consolidation Concerns
The mergers and acquisitions that we’ve witnessed over the past 20 years have exposed a larger challenge in the quality and quantity of healthcare and patient data, and worsened the interoperability problem that impedes collaboration and communication across the organization.

When multiple hospitals consolidate into a single health system, separate systems, processes, and data management strategies are merged. One organization’s inaccurate data is married with another’s, increasing the potential for even more incorrect information entering the system.

Having inaccurate or incomplete data being used in the delivery of care within one organization can have serious negative impacts. Sharing that information with other members of the care team, and across all organizations within a large health system, effectively pours fuel on the fire.

Each hospital or practice that is acquired or merged with a health system or IDN may not be using the same EHR system within their organization. If you look at any large IDN today, they will usually have at least two EHRs across their post-acute centers, ambulatory centers, and other offerings.

To remedy these issues, EHRs must find ways to increase practical information sharing and care coordination, and ensure the data that is available to their clinicians is both accurate and actionable.

Next-Generation Solutions
Vendor-agnostic technologies have emerged that natively integrate with a variety of EHR platforms, bolstering their functionality, adding capabilities, and allowing a better form of interoperability. They improve EHR usability, which in turn reduces many of the frustrations that fuel clinician burnout.

Technologies that can augment existing platforms are particularly attractive for EHR providers and health systems because they deliver better functionality and more capabilities without the need for their engineers and developers to invest the time and effort to build them from scratch or invest in custom integrations.

Consider, for example, solutions that enable care teams to collaborate and share information, even if they’re using different EHR platforms, delivering care outside of the patient’s current care setting, or communicating with providers offering third-party consultations. Using technologies that enable HIPAA-compliant messaging, telehealth, document and image sharing, and forms completion, care teams are more effectively integrated with minimal friction. Discrete and actionable information within EHRs can be securely verified between teams, and with clients directly, in a secure manner. IDNs and health systems that use two or more EHR solutions across their organizations can still share patient data more freely across care team members to facilitate better collaboration and communication.

Solutions that improve the accuracy of free text in EHRs are also proving valuable. Consider the impact of cleaner, codified medication history data that is free of duplicates and is displayed accurately at the point of care. This rolled-up data helps clinicians more easily find and digest the important patient information they need to make better-informed treatment decisions. Medication details and other relevant data also can be grouped in a way that improves clinician workflows and enhances the quality of data, which can reduce the amount of time that clinicians spend on administrative tasks such as calling pharmacies and physician offices to verify medication details.

The patented artificial intelligence (AI) in one medication history solution also helps to solve the problem of unstructured and missing free-text sig data. It populates unstructured data into standardized form fields, infers missing details, and automatically converts drug data and information into an organization’s standardized terminology to make sharing accurate and complete data easier and more effective. Healthcare organizations leveraging this solution can save about 30 seconds per prescription and reduce keystrokes and clicks by more than 80%. When aggregated across a single health system, the time savings can be significant.

As healthcare organizations address their needs for interoperability, clean data, and streamlined workflows, leaders should consider solutions that work with existing clinical systems to deliver care teams the information they need to ensure patients get the best care. By embracing vendor-agnostic tools that complement EHR systems, IDNs and health systems can add new functionality and capabilities to their existing platforms, allowing them to work better for the clinicians and the patients who rely on them.

This blog is part of a series introducing the concept of the Healthiverse, from Dr. First and is syndicated with permission.