EHR interoperability challenges and solutions

Electronic health records (EHR) are changing how healthcare is delivered and improving patient care. They have greatly improved health outcomes by facilitating decision-making, improving public health, and lowering costs.

However, the lack of interoperability among EHR systems has been a significant obstacle to achieving these goals. This article outlines the top challenges facing EHR interoperability and potential solutions to help overcome these challenges.

What is EHR interoperability?

EHR interoperability is the ability of multiple EHR systems to exchange health information with one another in a secure manner. While many different healthcare interface standards are in use today, the most common type is Health Level Seven or HL7v2 (or v3), which uses the Common Clinical Data Set (CCDS).

This allows information such as lab results and medications to be exchanged between providers using different software without any special coding on their part.

What is an Interoperable EHR?

An interoperable EHR enables seamless data exchange between different systems while maintaining the security and integrity of the shared data. It allows patients, providers, and other stakeholders to access accurate and up-to-date information regardless of the systems used.

For example, an interoperable EHR can sync with public health databases, ensuring that vaccinations or lab results are accessible across multiple care settings without manual intervention.

What is an example of EHR interoperability?

An example of an interoperable EHR is its ability to share a patient’s electronic medical record (EMR) among multiple healthcare providers. The patient may see a doctor at one hospital but can also visit a specialist in another state. The physician would then need access to the patient’s EMR so they can view previous test results, medication histories, and other relevant information.

Why is EHR interoperability important?

EHR interoperability helps improve care quality and efficiency. By sharing information across organizations, doctors can get better insight into their patients’ medical histories and make more informed decisions about treatment plans.

The benefits of EHR interoperability

The benefits of EHR interoperability include the following:

1. Patient-centered care: EHR interoperability improves patient care by ensuring that providers have access to all the relevant information about their patients at all times, which can help avoid medical errors or misdiagnoses.
2. Reduces cost: It reduces costs by allowing providers to share resources more efficiently. For example, by avoiding unnecessary tests or procedures when one provider already has that information on file.
3. Improved coordination and communication among healthcare providers:  It increases efficiency by making it easier for providers to communicate with each other quickly and accurately.

EHR interoperability challenges

Despite the benefits that come with EHR interoperability, there are many challenges associated with achieving this goal. These include the following:

1. Inconsistent data and lack of standardized data structure: One of the biggest challenges in healthcare interoperability is managing inconsistent data from multiple sources. Data in different databases often comes in various formats and types that may not be easily compatible. A single record may contain different information about a patient's medical history or treatment plan, making it more difficult for different systems to interpret correctly.
2. Patient privacy and security: Validating electronic requests for patient information is crucial to maintaining privacy, security, and compliance with regulations such as HIPAA. To ensure compliance with these regulatory requirements, users must ensure their EHR solution has sufficient controls to protect personal health information (PHI). Many providers have existing systems that may not work with new EHR products. A single breach of PHI can result in massive fines and reputational damage, so healthcare organizations need to take steps to protect their patients' information.
3. Lack of Communication Standards Across EHRs: There are currently no healthcare interoperability standards intended for all providers across the country, so each provider has its standards, which sometimes match those used by other healthcare organizations in the same area.

Why is there a lack of interoperability in healthcare?

Several systemic issues contribute to the lack of interoperability, including:

• Vendor lock-In: Some EHR vendors use proprietary software, creating closed ecosystems that limit data exchange with competing platforms.
• Regulatory complexity: While regulations like HIPAA aim to protect data, they can also inadvertently discourage data sharing by imposing strict compliance requirements.
• Fragmented adoption of standards: Although standards like HL7 and FHIR exist, their adoption varies widely across organizations and regions, further compounding the problem.

How to Improve EHR Interoperability

There are several EHR interoperability solutions available, including:

1. Cloud-based EHRs: Cloud-based EHRs can be easily integrated and accessed by data sources such as clinical, lab, and pharmacy systems. This ensures the interoperability of all these systems and improves the quality of care provided to patients. Cloud EHRs allow users to store data on multiple servers in different locations, making it easy to access when needed. They also provide strong security features to protect data from cyberattacks or unauthorized access.
2. Use Open Application Programming Interfaces (API):  The most common approach for achieving interoperability is using APIs. APIs enable disparate application and system communication, allowing data and protected health information (PHI) to be shared and communicated between EHRs and health information technology systems. APIs that comply with standards such as FHIR further simplify interoperability by ensuring data is exchanged in a predictable, structured format across systems.
3. Blockchain for Network Provider Identification (NPID): Blockchain is a decentralized, public digital ledger that records transactions in a permanent and verifiable way. By design, blockchains are resistant to modification of data and are inherently resistant to data tampering. It improves EHR interoperability by enabling patients to share their medical records with their healthcare providers as requested by the provider through a secure, private blockchain network. Blockchain provides some unique security features, like creating an audit trail (in the case of malicious actors) to minimize the risk of data loss.
4. Adopt nationwide standards: Encouraging uniform adoption of standards like FHIR and HL7 across providers and regions can facilitate seamless data sharing, reducing compatibility issues.

Conclusion

EHR interoperability is key to delivering coordinated, efficient healthcare. Challenges like inconsistent data, privacy concerns, and communication gaps require technical solutions, regulatory alignment, and investment in training and technology. Tackling these issues helps healthcare providers unlock the potential of interoperable systems and improve patient outcomes.