Top 5 EHR Interoperability Challenges (and How to Fix Them)
Electronic health record (EHR) interoperability is the seamless, secure exchange of electronic health information between systems. For decades, this was an ideal attached to the mass implementation of digital health records. While facilities worked toward exchanging fax machines and paper record systems for in-house EHR systems, interoperability among agencies (and even departments) took a back seat.
Now, facilities face the reality of working toward that ideal — at the risk of reduced reimbursement rates from federal programs and other adverse consequences. Let’s discuss the challenges that facility leaders often face when trying to achieve interoperability. We’ll explain why these common issues arise, what the root causes are, and potential fixes that you can apply to meet your interoperability goals.
What Is EHR Interoperability?
In theory, an EHR should account for every interaction a patient has with the healthcare system, regardless of what agency or provider they work with. This data should “follow” the patient from one care center to another.
However, this record can become fragmented and incomplete unless facilities have achieved interoperability — the ability to exchange electronic health information (EHI) between systems in a secure, efficient, and accurate manner. Interoperability involves sending and receiving digital information, and interpreting the information that’s exchanged.
What Are the Main Challenges in Achieving EHR Interoperability?
Issues arise for multiple reasons, from incompatible image file types to broad, human-factor challenges like organizational decisions about spending. Some critics argue that these challenges have roots in the industry-wide phases of EHR implementation. For example, while the Health Information Technology for Economic and Clinical Health (HITECH) Act initially incentivized EHR adaptation, there was minimal focus on how these disparate systems would exchange information.
What Is the Impact of Health Information Exchange Issues?
A lack of interoperability in healthcare can lead to:
- Fragmented patient health records.
- Inaccuracies and disparities among records from different facilities.
- Delayed communication between providers.
- Missed treatment opportunities.
- Duplicated services (creating increased costs).
- Inefficient use of health resources.
The Top 5 EHR Interoperability Challenges for Healthcare Facilities
The ability to efficiently transfer information can help healthcare teams work together to deliver cost-effective and high-quality patient care. Here are five challenges that facilities often face when working toward better interoperability, along with possible solutions and key takeaways.
1. Structural Incompatibility of Data between Systems
Incompatibility issues arise when there are structural differences in the datasets being exchanged among systems. This technical problem has been addressed in the past through standardized clinical data exchange “languages” like Health Level Seven (HL7) version two (v2) and version three (v3), which provide a common way for different systems to communicate with each other. However, HL7 v3 (which replaced v2) has proven difficult and expensive to implement. Despite these barriers, it’s still used in some situations.
Solutions: Currently, there’s a movement toward a more modern standard, Fast Healthcare Interoperability Resources (FHIR), which is designed to ease communication friction between systems. Federal policies are behind increasing use of FHIR. Recent data shows that 78% of countries regulate the exchange of health data, and 73% of those regulations either encourage or mandate the use of FHIR. This trend has been in place for the past two years and is expected to continue. Be aware that HL7 v3 standards are still actively used for some purposes, such as public health reporting.
Key takeaway: Focus on FHIR standards when assessing your EHR and interoperability objectives.
2. Advancing Interoperability Isn’t a Priority
When a facility or organization is struggling, tackling interoperability projects may come in last on the agenda. Leadership may not understand how the seamless exchange of information affects the financial bottom line.
Solutions: Resistance may shift when it becomes clear that achieving interoperability is no longer a long-term, future aspiration — but rather a current requirement. For example, the Information Blocking Rule within the 21st Century Cures Act makes it illegal to prevent the exchange of EHI. Furthermore, working toward improved interoperability and EHR optimization does affect a facility’s short-term financial situation through protecting against disincentives and penalties, streamlining operational workflows, and increasing revenue.
Key takeaway: Healthcare providers are required to enable the efficient exchange of EHI. Advancing interoperability can help facilities avoid penalties and make immediate operational efficiency gains.
3. Healthcare Staff Is Using Workarounds
An important element of the data exchange process within a facility and between agencies is the human factor. When workers at any point in the system opt to use a workaround instead of engaging with the EHR, the data going into the system is compromised.
For example, a clinician feeling frustrated with an inefficient EHR assessment workflow may decide to write personal notes about her assessments and then tackle the time-consuming electronic charting later on. If an incident occurs before she has a chance to input her assessment, her “practical” workaround creates missing data in the system and a barrier to EHR interoperability.
Solutions: Provide training on the importance of data integrity within EHR systems, and explain why shortcuts and alternative charting methods should be avoided. Establish open communication with staff regarding workaround habits. Why is the shortcut getting used? Can the inefficiency in the EHR be mitigated? Tackle barriers as a team, working together to come up with strategies to optimize EHR use.
Key takeaway: Facilitate appropriate electronic charting. EHR systems are designed to create a network of live, realtime data.
4. Highly Customized Workflows
Healthcare providers navigate legal compliance issues on a daily basis. With increasing regulations in place from oversight agencies, the daily pursuit to stay compliant requires a lot of time spent on documentation. One recent study found that physicians spend approximately 49% of their work hours completing clerical tasks, including time spent using the EHR, compared to 33% of their time on direct clinical tasks. Similarly, it’s estimated that nurses spend an average of 40% of their time on documentation.
It’s no surprise that organizations customize documentation workflows in an attempt to increase efficiency. The problem arises when these customizations deviate from industry standards, creating issues in the flow of data between agencies.
For example, a clinic specializing in addiction treatment may add unique, substance-abuse-related data fields to their EHR in an attempt to streamline the intake process. These custom fields may not be recognized by external systems. Furthermore, it can be difficult to update and troubleshoot a highly customized EHR, and interoperability problems can compound with time.
Solutions: Limit changes to existing EHR systems. If customizations are necessary for efficiency, ensure that there is a non-customizable gateway in place so that regardless of how the local user interface is structured, all of the data going out through the gateway meets FHIR standards.
Key Takeaway: EHR customizations should be limited and strategic.
5. An Outdated EHR System
There are more than 100 government-approved EHR systems on the market, and many are outdated. Legacy systems may have once been optimized to perform well, but no longer meet the technological, security, and interoperability standards of the industry.
It’s challenging for facilities using these systems to upgrade to a new EHR. Switching systems is often costly. It inevitably involves a disruption in work, sometimes for an extended period, followed by a phase of integration while the staff learns to use a new system. To make matters more complicated, facilities may be bound to their existing vendor through a contract.
Solutions: Though moving away from an outdated EHR system comes with challenges, it’s key to achieving interoperability. Modern EHRs are better suited to the data exchange goals that many providers are striving for. Research shows that hospitals using the top, market-leading EHRs report better patient access to data and improved patient-generated data submission compared to other hospitals.
Key takeaway: Exchanging an outdated EHR system for one that is current and competitive in the industry is an important step in meeting interoperability goals.
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