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BUSINESS OF
MEDICINE

Electronic Health Records (EHRs) and
Interoperability in Healthcare Today

By Joseph (Joe) P. Gonzales, MHA, FACHE

In a recent article on EHRs it sites a Government Accountability would develop a rating system for health IT products to measure
Office (GAO) report, released September 16, 2015, that highlighted interoperability, security, and usability. The goal of the legislation
some of the barriers to interoperability of EHRs. An “interopera- is to improve health IT transparency and interoperability. So with
ble” EHR system is one that shares health information with other that as a background, I will share some perspectives that would seem
systems and processes that information without much effort by the to ask “…can we really wait until 2024 to make this happen?”
user.
Various Perspectives
Identified Challenges to Interoperability EHR’s Design
The GAO interviewed 18 non-federal organizations to describe In a June 26, 2014 article by Marla Hirsch in FierceEMR, enti-

some of the main challenges that many organizations face in achiev- tled “It’s time to redesign EHRs to improve patient safety”, she de-
ing greater interoperability. They identified five predominant chal- scribes that providers have been “…lashing out against subpar
lenges: electronic record design for years.” Some of the reasons she explains

Challenge Details is that the EHRs are poorly de-
signed since they impede workflow
During the week of Oct. 4, 2015 the Office of the National Co- and cost too much, and they tend
ordinator for Health Information Technology (ONC) released its to create new patient safety prob-
final version of the health information technology (IT) roadmap. lems, and contrary to the promise
This roadmap aims to coordinate efforts across the country to im- – they don’t share data with other
prove health IT interoperability. This plan lays out a number of systems in order to help coordinate
goals through 2024 to improve interoperability and achieve better care. She further points out that
quality and outcomes. In addition, Congress is introducing legisla- there were studies in 2014 that
tion aimed at improving EHR interoperability. The legislation would support the premise that
EHRs, as currently designed, ad-
versely impact patient safety. One
study, by the Veterans Affairs De-
partment (VA), shows that 75 per-
cent of 100 EHR-patient safety
issues studied related to design is-
sues. Moreover, a huge 94 percent
of the safety concerns were traced
back to just four problems, all of
them design flaws, including:
• Unmet data display needs, such as small print or a “poor fit”
between information needs and the clinician’s task at hand

• Problems with software upgrades and modifications, which cre-
ated configuration errors

• System-to-system interface problems

• “Hidden dependencies” within the EHR, such as use of match-
ing algorithms that created errors and delays.

34 San Antonio Medicine • December 2015