Resistors and Connectors in EMR Interoperability

By Dr. Peter S. Tippett

September 14, 2017 — According to ONC, over 96% of hospitals and 78% of doctors use electronic medical records (EMRs)[1]. And while broad adoption of EMRs has been effective for enabling quick access to patient records within facilities and streamlining coding and billing, among other benefits, there are still many challenges sharing patient records and communicating patient information outside of the organization, between providers who are competitive, or geographically dispersed, between those using different EMR vendors, and even in cases when using different instances of the same EMR.

There has been a lot of focus lately on “data blocking” but for over a decade, many, mostly large health IT vendors and provider organizations have been reluctant to promote easy, ubiquitous, digital communication and medical record sharing. I consider these to be the RESISTORS – those organizations who fear the sharing of patient records conflicts with their broader business interests. 

The resistors are countered by numerous others, whom I call CONNECTORS. These include most independent physician practices, specialists, clinics (such as urgent care centers), support organizations (such as physical therapy or behavioral health groups) and probably most smaller hospitals. In fact, even in larger institutions, most individual clinicians, and their support staff are also in the Connector camp. 

Most people working in the healthcare system are interested in tools that help in getting their job done and in providing quality care. Therefore, most people (as opposed to organizations) relish easier digital medical communication.  Most scientists, policy makers and regular citizens (patients) are also Connectors. And with the shift to quality and accountable care, along with incentives from payers and evolving regulations, even some of the Resistors are getting on the Connector band wagon. So why is the sharing of medical records and messages still so difficult? 

I see several primary drivers for this market “conflict”:  

1. Market Competition – One of the dominant early reasons for the lack of easy health data communications has been business resistance by large providers and health IT companies as a competitive maneuver.  By seamlessly sharing digital patient records across town with competing facilities, the hospital potentially dis-incentivizes a patient from remaining within their own system. Similarly, the EMR vendor, seeking to become the dominant system in a region, benefits from volumes of patient data staying within their domain to prompt market demand and expansion to neighboring facilities. 

But even if these Resistors wanted to facilitate the sharing of patient data, there are numerous other impediments to seamless communications, including:

  • Problems with data structure

  • User security and permissions

  • Medical document standardization

  • Patient data mapping issues between technologies (and specialties)

2. The Ubiquity Problem – The value of any network to its users is a function of the number of users cubed.  We wouldn’t find phones or email addresses to be particularly useful if we couldn’t reach the right people, because a system that doesn’t include nearly all appropriate users isn’t likely to succeed. 

EMR adoption has generated exactly this type communication challenge because as an industry, we’ve created fairly closed user groups for each enterprise, when the real value to clinicians, to patients, and to the market is in the secure flow of medical information where it is needed. Health Information Exchanges (HIEs) assist in some areas, but don’t reach far enough geographically nor do they include all necessary stakeholders.

In addition to vendor technology platforms that break down structural, mapping, and other barriers, we need a national (not only enterprise-level) directory of clinicians to facilitate finding and communicating with the right person or organization, convey the right security and user permissions, and make it available at a reasonable cost.  And we need a way to get non-users easily on-boarded so that the network is truly ubiquitous. 

3. High Costs – Healthcare is a business, and across the industry, providers invest heavily each year in modernizing systems, equipment, personnel training, and related operational areas. Since 2009, technology costs at physician-owned multi-specialty practices have increased by more than 40%, with the largest increase in technology costs occurring between 2010 and 2011, during implementation of the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, which incentivized physicians and others to use electronic health records.[2] Similarly, investment has been tremendous for hospitals, ACOs, and other larger organizations.

After investing so heavily in IT requirements, the industry is understandably fatigued. Systems frequently require hardware and software updates, license renewals, integration, and user training, and consume thousands of staff hours to ensure operational readiness. So, trying to tackle the interoperability challenge is a burden, even in facilities that are motivated to succeed. Until the industry creates truly turn-key secure communications capabilities, resistance will remain.

4. Enterprise Focus – For many years, the financial industry has successfully moved billions of dollars in the blink of an eye by ensuring strong security and access permissions, with much of it driven by the needs of the individual. It is time for healthcare to work as efficiently, and technology is not the limiting factor. Much of this comes down to who is in the driver’s seat.

In healthcare, the dominant adoption models and drivers over the past 20 years have been focused on business-to-business (B2B) value propositions, sales strategies, and implementation methods rather than personal value needs.  This ignores two of the primary players in healthcare: the physician and the patient.

Consider for a moment how both the PC and the smartphone gained market traction and initial value trajectory by addressing individual needs. This trend continued with the widespread adoption of social media and other innovations. Indeed, broad cultural shifts rarely take place without the buy-in of individuals en masse, and to secure the future of communication and the flow of digital health information, the individual will need to play an active role in market adoption so the technology itself needs to be tailored to the individual.

Our focus should therefore be on creating cost-effective, secure, private and compliant communications, that empower the individual to share medical information while supporting enterprise needs. As an industry, we must significantly improve access, ubiquity, ease-of-use, cost, and remove other barriers that are impeding the healthcare industry from truly benefitting from EMR adoption. In other words, it’s time to give the “Connectors” a fighting chance.

Please drop me an email – I’d be happy to chat about how we can work together to make this happen.





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